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APPLICATION FOR SANITATION PERMIT Permit No, <br /> (Complete in Duplicate) <br /> Date Issued . <br /> dLr1 ) <br /> Application i' hereby made to the SantJoaquin Local Health District for a permit to construct and install the work herein described. <br /> This applicatiori.is made in compliance:with-County Ordinance No. 549. <br /> JOB 'ADDRESS AND LOCATION---- - <br /> --------- - ----- ---------------------------------------- <br /> s <br /> ---- - -----, <br /> =---- <br /> Owners Name = Q- �_N .-: } F' ' <br /> A / <br /> - t <br /> Pho e- <br /> _M. <br /> Address - ------ � Ga------------- <br /> Contractor's Name <br /> _ --- ----------------Phone_ <br /> Installation will serve': Residence�A part enf House j'Commercial ❑E, Trailer Court ❑ Motel ❑ Other ❑ <br /> . « ^F <br /> Number of living units: ,-Number}f bedrooms _----_--'Number of baths --/ Lot size --- _ -=-_X--_-_ ..,� <br /> fi 4 <br /> Water Supply: Public"system` Community'system '❑" `Private•❑-_ Depth to'Water Table -.�i <br /> Character of soil to a depth of 3 feet:,Sand-[].,'Gravel ❑, Sandy Loam'D.- Clay Learn Ej Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: Yes ❑ No U New Construction: ^Yes ❑ No ❑ FHA/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 /> 1� �o -Liquid <br /> r , <br /> Septic Tan . TDistance from net:well {'Qil _ Distance from foundation_-.�- <br /> No, of arescompartments-- Size- q 1 Capacity_. 5 - ___"__ <br /> Disposal Field: - e•from nearest.well-t4-orL`e__-°Distance frorn'.foundation:�1-9--�f�Distance to nearest lot line_,_.�__r. <br /> [ Ni1'r-nbe" '0 <br /> istanc <br /> r.of lines-_'-__1_-- `_ -- Length`of each line___ F______--:".Widih of french----.-r-+ rf----- <br /> Type of filter materYaLQ : iS Depth fffilter material'.' i� Total. length-!_--117 ___� <br /> Seepage t Distance to nea est welf tion hn __ Dt Distance fro unda#ion-., -_�3.'�..Distance to nearest lot #ine____07 <br /> _�_ <br /> Number of.pits- -x]�'----- 9 +� �_ __ ` r ��' �!=..Depth s , j <br /> ,. . I ' ..„ ,Size:,.Di�meter -� ---------------- <br /> t _ <br /> ---------- material ion--- <br /> t,c <br /> f i... - <br /> Cesspool:: is ante rom nearest well----'I - -Distan <br /> Priv Distance,from nearest`well--___--"_-__-- °___ <br /> +Size:-Diameter----=------=-- - ---- - ------ --De th <br /> Y r. e E-.-Distance from nearest building,____--' {.-----__--: <br /> --------•- - - <br /> ❑ - - - Distance'fo-nearest-lot-line ---------------- ­ -a--__� . T.._ _. . J. ._• .„_. _ , <br /> - ----i --------------- ---- -- t --- --�;------------ ---- - - <br /> Remodeling and/or repairing (describe): --=--=-----•-•----------- ------------------------------------------------------ <br /> r <br /> { : - <br /> I ----------- •-----_.. <br /> ' it s r.f ..r...t. <br /> -------------- ------------- <br /> ---- <br /> I <br /> = --••----- • •- <br /> � - -_.. x <br /> - - - --------------•----------- <br /> I hereby certify fhat.-I have prepared this application and that the work will�be-done in accordance,with San'Joaquin.Counfy <br /> ordinances, State laws, and r I s n gulations•of the San Joaquin Local Health District. <br /> ©AY,. ( Gq <br /> (Sig nA_EP_TfC:_-TANK SERVICE ` <br /> -- .-- -. ------ --- ------------- =-- - -Con+ractar) <br /> QQYY5 E;Miner Ave.a % ��Stt}ock=Be5AH& <br /> - <br /> Plot �n, showing sOr�o -A.; eRiME- --of system in.relaf o•wells,.buildings, c., can`be placed on reverse side). <br /> i <br /> ( P 9 <br /> FOR DEPARTMENT:.USE ONLY; <br /> APPLICATION ACCEPTED B I :'' DATEr' <br /> - --- ------------------------------- - <br /> BUILID NG P RMIT ISSUED = i'- - - -' - DATE `�' <br /> --- -- ---- ---- ------------ ------ <br /> T -- .- DATI ---- - - =- <br /> Alter tions and/or recommendations: tM'd � ^.,✓I 1 , t.,. � <br /> - ----- , - <br /> ---- --- --------- <br /> _ ---------------- <br /> _IJ--------------------- + .---------"-----" <br /> --------- --------- <br /> -- �CS <br /> ------------------------------ <br /> -7 FINAL INSPECTION BY: <br /> `----- -----•---- - I <br /> �V� , _ <br /> Date ---=----------- - -------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore S}r Noi" 8 North "C" Street <br /> Stockton, California Lodi, California Mantace;Califofnla `��} Tracy,kCalifornia <br /> .�ilf��,d II+OT11^ f .-OVA f s611t., ., <br /> ES-9-2M , Revises 1-57 F.P.CO. tnswOH R <br />