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rVK lJrhk_c JC: <br /> A CATION FOR SANITATION PERI Permit No. ....................... <br /> ------------------ -- (Complete in Duplicate) �,` q.................. ..___..-_. This permit Expires 1_YearFrom- Date Issued <br /> Date Issued <br /> -- _ ...................... <br /> Application 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 with County Ordinance No5-49. ./� <br /> JOSADDRESS AN OCAT N --•----------------------- --- -----------------------------------.----------------------•--•-- .....------------ <br /> :.; <br /> Owner's Name__ --- = - Phone---•--------...-_-------------•--- <br /> Address--------- ��,�f/- -- �y <br /> Contractor's Name----- ---.....--! =may'-'"_--- •--------- Phon1 <br /> Installation will serve: Residence M,- artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: .._ Number of bedrooms _:w2_ Number of baths ---/. Lot„size .... D__f ........ <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table%;F7�? ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay ❑ Adobe [B-�'Rardpan <br /> Previous Application Made: (if yes,date____________________) No New Construction: Yes ❑ No [a,'�HA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION `AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> S pts nk; Distance from nearest well_________________Distance from foundation--------------------Material.................................................. <br /> No. of compartments--------------------------Size.................................Liquid depth---------------------.__.-Capacity.................... <br /> ... <br /> Disposal F d: Distance from nearest well-,5.'.O_._.Distance from foundation_._ �_____-Distance to nearest lot line.. ....... <br />� Number of lines___.___..: <br /> Len th of each line____ O-----------------Width of french----- <br /> E. E° Type of filter material. _Depth of filter material______,1'_J'........Total length______________________3_d_________. <br /> SeepageIt: Distance to nearest well__`aCL________Distance - m foundation_. 0-_._-__..Distance to nearest lot line... (� <br /> ' Number of pits-----/-------------Lining maferial_. QC_e----.Size: Diameter.____3_3_ t.._...Depth___-____a_!;-_'____________ 1 <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__._._________-_____.________________ <br /> ❑ Size: Diameter-------------------------------------Depth----------------- ,----------------------------..Liquid Capacity---------------------------:gals. <br /> f Priv Distance from nearest well----_____.--.--__-____ :Distance from nearest building <br /> I ❑ n.t <br /> Distance to nearest lot line-------------------------------------------------------------------------=----------------•-• --•--------...-•--••---.._..--•-•----•--------- <br /> f: <br /> i Remodeling and/or repairing (describe):---------------------------- -------------•-------•---••-------••••----------•t-----_---- ---------------=----------------- ....................... <br />{ <br /> ---•---•--------------•---•-------.-.-----------.--•-----.----- -••------------------••--------------------------------:-------------------=----------•-------•---------------------------•--------•-------------------------- <br /> -----------------------------•-----------------------------------------------•--------••------------ --------------------------------------------------------------• --------------------------.-- <br /> I hereb certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinanc tate laws, a' rules and r gulations o he San Joaquin'Local Health District. <br /> {Signed) a VA ------------------------------------ <br /> .. Owner and/or Contractor) <br /> sY� ................ ............. ----------------------.(Title) ------•-------------. - -------------- <br /> (Plot plan, showing size. of lot, location f system in relation to IIs, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------ `------ ---------------- DATE-.....7.�.. ....... ----------------- <br /> ------ ---- ----- ------- <br /> REVIEWEDBY------------------------ - ---------------------------- DATE------------------------------------------------------------ <br /> BUILDING PERMIT ISSUED-------------- --------- -------- --------------------------------------------------------------._. DATE--------------------_--•---------- ---------------------- <br /> I Alter tions qnd or ecommepdati ns__________________________ _____ ___._._..._..__.____ <br /> (e 7/ n <br /> �-- -- --- - - - -�-,� ti- -� � . ---- r: :,...--- -------•--- <br /> ------------------------------------------------------------ ---------------------------- ----•-g--------------------------------------------------•-------------- ---------------------••-- ---------...----- <br /> --- -------------------- <br /> - F -------------------------------------------•--------------...------------------------------------- <br /> FINAL INSPECTION BY: � <br /> t <br /> --•- -_. Date----- <br /> - ---------•--•----• ---•--•-------•--•---------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South Arnerican Street 300 west Oak Street 124 Sycamore Street 405 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> CS 9 REVIRED S-.59 2M 5-61 ATLAS <br /> F <br />