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FOR OFFICE USE: <br /> APPLICATIOte FOR SANITATION PERMIT Permit No. _4971::3�_'V <br /> ................ ........l'.......................... (Complete in Duplicate) / <br /> Date Issued <br /> -------------------------­-- This Permit Expires I Year_From. Date-Issued <br /> . <br /> Applica-tion is hereby made to the San Joaquin Local HealPh District for a permit to construct and install the wort: herein described. <br /> This application is made in compliance with County Ordinar�. 549. <br /> JOB ADDRESS APD LOCATIO ... ... ...... ............ ...... .......• o <br /> .....................5r.` <br /> Owner's Name--- •- .LLE'-- - �- -�� -�--�-�-��-�•�---------•--------•--.._. . <br /> ........ Phone------------------------------------ <br /> Address...... ....�.Q.. ._....; - _ <br /> Contractor's Name. i FF ---------------------_----- <br /> Installation <br /> -------------------- --•.._Installation will serve: Residence ❑ Apartment House Commercial 11 Trailer Court ❑ Motel ❑ Other ®IP441 7- <br />'� Number of living units: ........ Number of bedrooms - ___-. Number' of baths .._...-- Lot size ... ........... . ........... ........................ <br /> Water Supply: Public system ❑ Community system ❑ Private W Depth to Water Table4m. ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date...........:........) No 9 New Cons+ruction: Yes ❑ No 06 tHA/VA: Yes ❑ No Ek <br /> '= TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tao: i]istance from nearest well Z.�_.._._.Distance from founds+ion_-/. ............Material__• __ .---__•____-.-. -.-_-__-_-_--__•_- <br /> i No. of compartments.-!k................Size-.14.rr,...........-- Liquid depth..X21.............Capacity.lZRm.6!4`�-r <br /> Disposal field: Distance from nearest well..�� �_.Distance from foundation__Z d. __.._.Distance to nearest lot line_' JIM.� <br /> Number of lines.. .__�� Length of each line..._.�s? .. Width of trench__-774_.r!___________________ <br /> li r <br /> Type of filter material.. c .......Depth"of filter material-..I. ......-....Total length...--..IVSD........................ <br /> Seepage Pit: Distance to nearest well---I -------Distanc"-rom <br /> undation../Op.......Distance to nearest lot line..� -' <br /> PC Number of pits--- ----------:Lining material. .....Size: Diameter.... .... ....Depth....i� --.-------.------- <br /> Cesspool: Distance from nearest well...........:.....Distance from foundation---.................Lining material............._......._....._..__.._... <br /> (� Size: Diameter--------------------------------------Depth----------------=---------.........................Liquid Capacity------- ----•---------•-gals. <br /> Privy: Distance from nearest well----..............:........................ ....Distance from nearest building <br /> _._._......_..._.......................... <br /> �] Distance to nearest lot line.................................................------------......_... -_ ........................................... <br /> . f! � O d <br /> Re odeling and/or repairing (describe:-- 11Q.{Gf�.--- 1. -... .� �/_t�, ----------- - <br /> .._......... �...... --------------•------------- <br /> s�L.-- � .--------------------------------------------------------------------------------------------- <br /> 1 -U-4 It L•-------------------------•-------------------.....-..----------------------------.......-.._.------------------------------- ------ <br /> I hereby certify th ave prepared this application and that fhe'work will be done in accordance with San Joaquin Coun+y <br /> ordinances, State laws, an rules and regul ons of th/San quin Local Health District.- <br /> ......................Owner and or Contractor(Signed)-----••---------•----. -----•-- • • . --.... .- ; ( / ) <br /> Z <br /> By:-----•--------------•-•••-----------•.. ` 6•C ------ .--- -----------------------(Title)------ <br /> (Plot plan. showing size of lot, location�of system in relation to wells, buildings, etc., can be plae d on reverse side). <br /> EPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY , . _ DATE /•• Ir -- -_-------•-----••-•-•- <br /> r <br /> REVIEWED BY::...... ------------------------------------'--•-•--• .... DATE-------� - - <br />� <br /> BUILDING PERMIT ISSUED..............�...� -�-.-�-=-�-�----------�---------------d-�-----�,_-`�![-!?�-.....-----•----------------------•------------------ <br /> fAlterations and/or recommends+ions:.._/ <br /> :.. <br /> a . . . <br /> FINAL INSPECTION BY:-.------- .. ------------- Date----/--------- ----------- <br /> UIN LOCAL HEALTH DISTRICT <br /> 1501 E.tfaselton Are. 300 Wr e k Sweet 124 Sycamore Street 205 West 9th Street <br /> Stockton,Cotifo*nip Lodi,California Manteca,California Tracy,California <br />