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t-Uk U"ICE USE: <br /> _71— <br /> ......... ............ .......... <br /> 'APPLICATION,'-FOR SANITATION PERMIT Permit No. ___r.................. <br /> J' <br /> s �f_L 6Ej'WVI E Complete in Duplicate) <br /> This Permit Exp irsis 1 Year From Data Issued /— G <br /> Date Issued ...................... <br /> Co/ 2-227_(O <br /> App,ica tion is here6y made to the San Joaquin Local He'alTh District for a permit to construct ana instal!the werk her in deserlbed. <br /> This applica-ion is made r mpliance with County Ordinance No. 549. IPO <br /> JOB ADDRESS AND OCATI .- � 4EQ <br /> Owner's Nemr ... � <br /> o ........ . Phone_ <br /> Address. <br /> 7 —r _ I <br /> Contractor's Name...-----.. f.R>� -T-.F—C .. fill t.......... <br /> Installation will serve: Residence erfTnen+ House f <br /> F `❑.' Ccmmerciel ❑ Treiior Court Q MMo�+el ❑ Other ❑ ,•� <br /> Number of living units: ..... Number of bedrooms .Number baths J.... Lot size �F►��_.. <br /> Water Supply: Public`systern F� Community system ❑-+f tPriv8fe Depth To Water Table <br /> Character of soil to a'depth of 3 feet: Sand Gravel ❑ Sandy Loam Clay Loam [I Clay E] Adobe ❑ Hardpan ❑ <br /> Previouslicetion Made: .(if es,date_... . I <br /> APP _ryy_ f�No [jYn'ew^Const-uctian: Yes _No_❑_,-FHA/VA: Yes ❑ No `! <br /> TYPE OF INSTALLATION AND SPECIFICATJONS.� _ <br /> (No septic tank or cesspool permitted if public sewer is available within:Z00 fV <br /> ' <br /> V �u <br /> Septic nk: Distance from.'nna est we!I a--.--D'stance from foundation.. .-......Mot r'e1..V C �l� <br /> JISpCSAI Field: D stoner from rnoerast w� lt'GX. x- -•Liquid depth ._. . " .-._ <br /> No- of r <br /> p . --....._C. Ipouty--- 4 <br /> ei.) ..,.-Di_tance from (uunCioti n.../Q - '..D stance to nearestft li� _-_-•- � <br /> Qr %'um(�er of lines .......�L ------ .. . ...�-Langth of each lire ....`. . Width of •rench. Ag-Y <br /> .• <br /> Type od filtermate fiat` OALC: j,± D�otn of =filter mater al. . .1$ Total IangrF / <br /> _............. <br /> Seepage Pit: Distance tc nearest welt '.•,,., .p;s�ancn f•orr foundation................ Dis*anco +o nearest lot line...._..._ _... <br /> ❑ Number of •;tr. .. --------... .Lining material-------- - - S-ze Die•ne+er. .•---- t7epth........._....... <br /> � # .......... <br /> Cesspaoi: Distance florn•nearest well,_ ......Pistance from founcatior... . Linirg materia;.. .....»_. <br /> ❑ S'ze: Diameter_... -bent#;�^+..-..-. .Liquid Capacity gels. <br /> _..-.. - <br /> Privy: Distance from nearest well _. ............. ii ... Dis=ance from nearest 6L1dir. _-,•,�- I <br /> ❑ Distance to r."fe.t ot,line...'IV C7............ . S .•._ <br /> _ ... <br /> Remcde,nq and/or repairvnq (descnl�e)• 41 Ips• � ..................... .. ---------- ... ...-----._._. ._...._......_.._.....-•-•----- .._.. <br /> ..... ._.I <br /> - --------------L. ...... <br /> I <br /> ......._.__.._-------------------......... { <br /> »-------- ................ ..-............. ..............•- ..._.. ._.._..-•-------..--. ......-•--...-•---........................................................ <br /> ...__...-... .,.... ~1 <br /> I hereby ce 'y that I have s this application and that the work will be done in accardence with San Joaquin County <br /> ordinances, S and r s/ it tions of the San Joaquin Local Health Disfrict. <br /> )Signed.- - --{ ner / <br /> _ . ......... ..... .. ,,.--,-......,,.., ............... .Ow and/or Contractor) <br /> ey:. _ . . .............................. _.._... - --.....{rtle)................................ <br /> (Plot plan, showing size of location of sysfem in relation +}o wells, buildings, etc.. can be pllacoid on reverse side). <br /> FOR DEPARTMENT USE ONLY - <br /> APPLICATION ACC>PIED BY.... ...<........_ .. ...........................---............... DATE......./_..... :P - <br /> REVIEWED BY..... <br /> BJILDING PERMIT ISSUED. _. ... ._... .. ..... . - __ .... ................................... DATE.........._........._.._ -....... _ <br /> ...... ............_....._..,............ D T _ <br /> Aheratlons and/or rrscommendations .............. ......-........-.............................................._._..__ ......----_.; ............... .. <br /> ................. :....... <br /> _-»_.-.... .�.T ..... ...wr. . _ <br /> , ... ... . .._._____...__ .,........._..._..__. -• �;._.__._........ <br /> ......_...__•.....................__..............._.. .. ...... _ <br /> I ..... ..................... ................................................ ................... ............. .. <br /> t <br /> --•-...»............... I................. . ... 1 — <br /> . .,.ti._'.� ...... ................... _ ............. <br /> FM!AL INSPECT'Or BY <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 Seuth American Street 300 We4t Oak sneer 144 sycamore Street 205 Wart 9th Street <br /> Stockton,Coliforniv Lodi,Calllornia Manteca,California Tracy, California <br /> ES 9 P.EV15Ea 8-5'l i�M 5-62 ATLA6 <br />