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rUK Utt-IC:E USE { <br /> _ <br /> - - <br /> ... .... .., 'APPLICATION' FOR SANITATION PERMIT Permit No. ..... ...... / <br /> Complete in Duplicate) <br /> Ex;ires 1 Year From Date Issued <br /> - - Dote Issued ....... <br /> App.ication is hereby made to the San Joaquin Local He'aiih District fora permit to construct ona instal:the work her in described. <br /> This application is made rn mpliance with County Ordinance No- 549. `pp ' <br /> /�/� t <br /> JOB ADDRESS AND OCATj�i`TF 144E <br /> Owner's Name....... K�.x <br /> (F. .....1 Phone <br /> Address_ — <br /> Contractor's Name..----- .. R.Al-T.ECA......'F rPT' !C. ,S EP U 1 C .. Phons........� ..._.��'l.. <br /> Installation will serve: Residence ��partment !-louse E]. Commercial E] Trailer Court ❑ /Motel ❑ Other ❑ <br /> Number of living units: ..... Number of bedrooms rnber baths .1.... Lot size <br /> Wafer Supply; Public system (] Community system ❑t tf'rivate Depth To Water Table l ft. <br /> Character of soil to &'depth of 3 feet: Sand /Grave <br /> Q) I ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ , <br /> Previous Application Mede{icy:—_ -date-... .)/No Q�fti'ew^Construnion: Yes �o_❑-- FHA/VA: Yes ❑ No 9j <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:/ f6,44 <br /> (No septic tank or cesspool-permitted if public sewer is available within f00 feet: !jam <br /> Septic nk: Dista-ice from.'nea•esi well O-._-D'stence from foundation.....-:.--.--.. Mot riei.. <br /> No. of cornpartmo-,+'1T'--. p V ....-----'Capacity <br /> a �=�-- ..I'zc,,�' X.�/---X .1�.. 'Liquid dap+h......f�-. . •-� . <br /> �! t <br /> Jispcsal Field: Distance from nearest.wefl . Dhtance from <br /> to nearest I fi �... <br /> Q� ;cumber of lines.-__.-'1_._^ Length of each lire �...-`. . �r ,`Width of •rench. <br /> Type of falter matarieJ,RQ_L +,.Denth of jitter mater'al. __..Total longth. _ <br /> Seepage Pit Distance is nearest well...........'.,,,,-.8isfancn from foundation. _-_ ._...... ...Qisrenca to nearest lot lire ...__.. ..._ <br /> ❑ Dumber of pais....-----_--.---- --Lining material---------- S-ze Diameter....._................Depth........._............. <br /> Cesspoo�: Distance fiomt•nea-est well. ...............6istance from founoation.... .............Liming material.. .... <br /> ❑ S4e: Diameter. } ......... --... 7Depi#,"71'► ............Liquid Capacity............»»............gels. <br /> 4 <br /> Privy: Distance from neoresi well ...--,�_--------- .Distance from nearest buii!ding...______......._..... 1 <br /> ❑1 Distance to nearest 'ot,line...... `...... !_.... .. .......— r-...� _......_.._��. <br /> 1 . A"t o ; ».»..... —..�........._»�.... <br /> erino"ing end/or repairing (descriue) _)fie ........... ._ .............................._ <br /> - .............. <br /> ..__.. ... ...........----------..._..._' ---- Y�.�...... .� ---- ..---- <br /> .... »»».._........._......._.�.._..».. ....»._ <br /> ..----•-..... ........ <br /> ........................... . -- .................... .........--- .. <br /> I hereby ce 'fy that I have this application and that? the work will be done in accordance with San Joaquin County <br /> ordinances, S and r s d:r tions of the San Joaquin Local Hoalth District. <br /> (Signed). <br /> {Owner and/or Contrecto_rl, — <br /> By:. ............ ----- ...... _. .............__... .__ .'......... .......... ..(Title) _... . .. ........... ... <br /> ... .- I <br /> (Plot plan, showing site of , location of system in relation to wells, buildings, etc., can be placed on reverse sidel. <br /> FOR DEPARTMENT USE ONLY <br /> -- <br /> APPLICATION ACCEPTED BY.... �Rr'IQ ... ....................................... _ ....... DATE_.. <br /> REVIEWEDBY__ ------ -•-----•... ....................... ................................. .......W.._.�._ DATE.,..................... ....................._........ <br /> BJfLDINGPERMIT ISSUED.. ....-•---.....................__._...._»..............._..........-•-•••--------•-•......... <br /> DATE............. _ <br /> Aherations end/or recornmendetions:.................. ........._ ._....._._............ <br /> »..__ ___....... ...».»..--........»...........» _.. .... <br /> _......«. ..............__.....�-i•.` •-_.............._...__.._....._...................................­__......................_.......__._ <br /> ._..._....�...._................................ ........._........................... ......... _......!'r .......................... ............»------ <br /> _............_.....-. _..._-....._..._ <br /> _ ................._................ ........... .. ..... .'. ............ a...x. 3 A iM_ .................._.._-._................ ............ <br /> ......._........._»__..-.................. ... ....s. ...r':..# - .................................. <br /> F-;NAL INSPECT'O BY- .. Date-. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Straw 700 Wa4t Oak Snot 124 sycamore,Street 203 Wert 9th Straat <br /> Slocktonr California Lodi,Colltornie Manteca,California Tracy,California <br /> ES 9 REVISED 0-b9 2.q n-6Z ATLAG <br />