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.,FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT Permit No. ..,C i <br /> - <br /> ---------------- - (Complete in Duplicate) <br /> ...__.---_-------------- This Permit Expires 1 Year From Date Issued Date Issued ......T / <br /> .... ... <br /> - <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the w A herein dascrbe--d./I <br /> This application is made lin compliance with County Ordinance No. 549. �5sr -QfV ) <br /> JOB ADDRESS AND OCATION_ l4�-. I'......ll�) -1 u------ .? T .L-�J.... �..... _..M.:..-- <br /> Owner's Name.-------JGK_�:-------va_tN---` � } Z -------- ........----....... ........ Phone_.( <br /> Address...._ .K...... 1..a......":......r, . .4.4a;0V..I ................................................................................... <br /> j.6. .M. <br /> Contractor's Name_ .lgyq....._.. ..A.t..bER_.v. ..!............................................. Phone................................... <br /> Installation will some: Residence House [] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: .'..... Number of bedrooms.. Number of baths .fes-Lot size ......rS.Q..__._!z. R ..._..... <br /> Water Supply: Public system ❑ Community system ❑ Private Depth T ater Table�p ft. <br /> ' Character of soil to a depth of 3 foot: Send ❑ Gravel ❑ Send Loom Cley Loem ❑ Clay ❑ Adobe❑ Hardpan-[], <br /> Previous Application Made: (If yes,date....................I No M New Construction: Yes [Pf No ❑ FHA/VA: Yes ❑ No <br /> ' TYPE OF INSTALLATION AND SPECIFICATIONS- <br /> (No septic tank.or cesspool permitted if public sewer is ave'lable within 200 feet.) <br /> f t <br /> Sa tc nk: Distance from nearest welLs�.d...,Dista a from foundafiion..` D.Sf M?ance <br /> ......�'F>n� (}1: T <br /> P No. of compartments..__._.7 Size-f:A.!�PX_�quid)d�e7 th...... eDisposal field: Distance from nearest well.110..... Distance from foundation....,199.......Dito nearest lot linaJ...�...:::: <br /> e <br /> Number of lines.......".,>�'..lt....�� .Length of each line....... _.7+��•Width of tre'ch..:.:.'J�.��.............. <br /> Type of filter material... 'Q. .iDapth of filter mate .......:_..Total length..,.:.....:./s1 '.......r. <br /> Seepage Pit: Distance to nearest well...................:--Distance from foundation................Distance to nearest lot line................. <br /> ❑ Number of pits......................Lining material........................Size: Diameter........................,Depth................................. <br /> Cesspool: Distancerfrom near.est well..............LDistance from foundation---.................Lining material..................................... <br /> ' Size: Diameter.............. ................:..D`epth.........._........ -"--......"----"----.......Liquid Capacity.........—•---............gals. <br /> ❑ ++ . <br /> Privy: Distance from nearest well------------ ---!__......_...___..._....__.Distance from nearest building.........._..._...._------------_-- <br /> Distance to nearest lot line... ,;._... i _ -E.. ...----....._..-- ._..._....._— -........' ..........._ --- <br /> Remodeling and/or repairing (describe):............ ............. ..j..t .... <br /> ..................._...................._......-----............e ._.......__.........._ ).................................... <br /> ...---• <br /> ..... :."�.. ....._.................._................... . ......... <br /> ._........._ ... .. <br /> ------ ................................. ... _ <br /> .................-...._........__...-----•----..................._-----• ------'--'----- `'--•-- • <br /> -:--xr <br /> I hereby certify that I have prepared this application and that the work will be done in,accordant-with San Joaquin County <br /> :.ordinances, State laws, and rules and regulations of the SaniJoaquin Local Health District. <br /> j $ wner and/or Contractor) <br /> (Signed} 7l.• �+7.__�Ca1_��R/ -; ........... ---...... ..... ...........................r O <br /> ........... ---- <br /> W <br /> .............:.....--------------- ---------------- ----------------- -° - -...................(rti ................. .._............... <br /> ' (Plot plan, ihowing size of lot, location of system in relation to wells, buildings, etc., con-6 pieced on firrorse side). <br /> i FOR DEPARTMENT USE ONLY, // <br /> APPLICATION ACCEPTED BY_...`��.R,.C,�_._...__....._.._.....------------------------------------------- <br /> REVIEWED. BY....................:---A.............................:-----•..........._._----......._......._....."...._.............. DATE.................._....................................... <br /> BUILDINGPERMIT .I•SSUED--............. ...................................- - ----------------.... DATE..................._.........._:---........................ <br /> Alteration and/or retommendationii...................--..........................._.......-..........................._....._........-........_.................. -- ......... - <br /> ' '--------------------------'---------------------------------•-------7--------------_----------..._..rr.-............:....--------.....=-.-----------.......-----------------...................... <br /> _Ci,t 1 -`- 1A .............."•-------"------------------------------- <br /> ' FINAL INSPECTION B '/0�- /f <br /> Date.............. <br /> _ Z 7_`_5�. - ... <br /> ' SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wert Oak Snoel 124 sycamore Street 205 Wwt 9th Street <br /> .. Stackton, California Lodi,California Manteca,California Trecr,califamta <br /> ES 9 REVISED 8.59 2M 5.62 ATLAS <br />