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` APPLICATION FOR SANITATION PERMIT Permit No. ....1/6.1/..�. <br /> (Complete in Duplicate) 5/ Y7 <br /> Date Issued .-..-/. _SZ-.-.. <br /> 1491%Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance withn/ ounty Ordinaan-ncc�e No. S4,9��ff N _ � Coi-hh <br /> JOB ADDRESS AND LOCATION-L-1.- . .1 1Q-------- a.:1.�_�--r. fes`--- <br /> Owner's Name.-` -t 1 f m -.5 k. ef n.. L'-'--------------------------- --- ---------- - ----------------- Phone--------------- .................. <br /> Address------ -` s� -� - h -- - - ------.. .......... ------------ -------------------------------- <br /> Contractor's Name.--- e>:L- 1 �19�. .�`-7`- lr -' - ------------------------------ Phon <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ <br /> Number of living units: _-4. Number of bedrooms .3_4_ Number of baths ..T Lot size ----------_-------__- <br /> Wafer Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table-,Igft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[g--Hardpan ❑� <br /> Previous Application Made: Yes ❑ No [R'�New Construction: Yes ❑ No E� r7in��E' "a <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> ETom)/ Distance from nearest well-----------------Distance from foundation.___---...._-_..Material-._-.-. ....___-- <br /> No. of compartments__----.---------Size---- Liquid depth----------..-----------Capacity-.-----------------' <br /> l Distance from nearest well--------------._Distance from foundation--------------------Distance to nearest lot line_-------------- <br /> Number of lines---------------------------------_Length of each line....-------------------------Width of trench----------------------------------- <br /> Type of filter material_.._..-_..__-.-_.-Depth of filter material_....___..._-.-._Total length....----_-.--.--_....................... <br /> qq i <br /> S �,ge JP-t: Distance to nearest wells ....._..Distant rom f9undation...I ._...Dist to nearest lot line_f- ---._.. <br /> L Number of its.... .. Linin materi0l b ._JIT, ...Size: Diameter__ "_De th...,.�..�-' <br /> Cesspool: Distance from nearest well----------------.Distance from foundation__..............Lining material-------------------------------------� <br /> F1 Size: Diameter----------------------------......Dept h----------.-......_----------------------------.Liquid Capacity---------------------------gals N <br /> Privy: Distance from nearest well--- ------------------------------____._--Distance from nearest building.---...-_---_.----------.---..-._.__ <br /> ❑ Distance to nearest lot line-----------------------------___------------------------_------'------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):----------------. ......__-----------........_--------------------------------------_....----..._..---•-------------------........... <br /> -------------------------------------------------------------------------------------.--------------------------------------------_- ...........------------ -----------------------------------------------_._._ <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinance r to laws, and IrYs @nd reNIGpel tions of the San Joaquin Local Health District. <br /> Septic Tank SeM"I Contractor) <br /> (Signed) 4396-so:-El- reilo---H'1­140i­------ <br /> By:------------- ---06..--..... n. �oNf.-------- - - - ----- ---- .._... - ----(Ti+leJ. �t1---------------------- .... <br /> (Plot plan, showing size of lot, location of syste n relation to wells, b dings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.`- ----- ------- ---------------------------------------------------------------- DATE.-"- '----_---------------------------------------- <br /> REVIEWED BY----------------------------1,---- --- ---- ---- <br /> .-------------------------------- <br /> ......_. DATE.-zA-- --------------------_--------------_---- <br /> BUILDINGPERMIT ISSUED....--------`u ------------ -------------------_------------------------------------------- DATE-----'&-------------------.........---...-...... <br /> Alterations and/or recommendations--- --------------- - -------__ ------------- _--_----------------------------------...........rs--- ......... -------------- <br /> _..-----------------------------------------•-----......................... <br /> ---------- <br /> --------- ----------------------- ................................. <br /> - ----------------- - -- -... - -------------------------------------------- ------------------------ > - - ----------------------------------------------- <br /> FINAL <br /> v------------------------------------------ <br /> i ;2Date--- <br /> a , <br /> FINAL INSPECTION BY:-.--------� ` '' ------------.. - - - r `-...----------------------------------------- <br /> SAN <br /> ...- ..... - -...... -SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street - 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M l�eM[ PTwoO4 i1-5L <br />