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-------------- ---- ............. - ..... <br /> -------------------- _. .......... __-_.._._. . ` ICATION FOR SANITATION PE. T Permit No. ._4ky';n__- <br /> ---- ---------- ---- -- ----- ---- --------- ----- -- (Complete-in Duplicate) <br /> Date Issued _ �_ <br /> ..._..._ . ..... -..._.._.._.__............... This Permit Expires 1 Year From Date Issued �/S e�� <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?49�Counnt' AL y Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION-4/ . .---- /V/A17_ C� C� ' �' �� ------------------------------- <br /> Owner's Name-------._0/74?_S- <br /> /✓. '_/-+� ---- -- ------------------------------- ---------_ P one----------------------------------- <br /> Address �J� s- 1- --::- ------------- -------------------------------------------------------------------------------------------------- ------------------------------------- <br /> Contractor's Name----- - 1 ---- ------- -----------------------_----- -_----------- Phone-•---- ------------.------ <br /> Installation will serve: Residence V[- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _/___ Number of bedrooms.._ Number of baths „2-__ Lot size _______________________ <br /> Water Supply: Public system ❑ Community system ❑ Private kqlepth to Water Table 1,;7-ft <br /> Character of soil to a depth of 3 feet- Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam E] Clay Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date..----------------- ) No V5oo`New Construction: Yes [ o ❑ 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 /> Septic Tank: Distance from nearest well_. t Distance from foundatjon_l __........Mat Material e(�¢__�-�__..____----_-. <br /> [�" No. of compartments.-A---_.-_.__-_--_Size? .__+_/= �Liquid depth_�j� ..... ........Capacit)V_10�44rl51___ <br /> � 1 s <br /> Disposal Field: Distance from nearest well_�i�-----Distance from foundation�/.fl__.... <br /> .__...Distance to nearest lot line__�_�_-_ <br /> Number of lines_-_• _...- en th of each line.ef _ <br /> 9 �------._ Width of trench-�.--------------------------- 67 <br /> Type of filter material`� Q . Depth of filter material...�F----------Total length___t' .Ole-________________________ <br /> Seepage Pit: Distance to nearest well......................Distance from foundation--------------------Distance to nearest lot line................. \ <br /> ❑ P 9 --.. Size: Diameter----_-----_---------Depth------------- ------•---------- <br /> -- �3 <br /> Number o its___ __________________Linin material <br /> 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 /> ❑ Distance to nearest lot line ------------- -------------------------------------------------------- <br /> ------------------ ---------------------------------- ---------------------------------------------------- <br /> Remodeling and/or repairing (describe):---- <br /> ---•--------------------------------•-- --------------------------------------- --------------------------------------------------------- ---------------- ---------------------------------------------------- <br /> --------------------I----------------------------------------------------------------------- <br /> ••-•-----------••----------------------------•-----------------------------------------•--------•-•---•-----•-•---------------- --------------------------------------------•--- ------------------------------------------------------------ ------------------ <br /> --------- <br /> ------------- ------------ ----------------------------------------I--------­---------------------------------------------------------------------------------------------- --------------------------•---------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)---------------- :-A--- ----------------- ------------ -- ------------ ------ ------------( cVor Contractor) <br /> By:-------------------------------------Anof/,ystem <br /> `-- ---------------------------------------(Title)_ /`�✓1------ -----.. .... __-------------- <br /> (Plot plan, showing size of lot, loin relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY- - - ----- DATE <br /> REVIEWEDBY--------------------....... ------- ------------ -- -------------------- - DATE <br /> BUILDINGPERMIT ISSUED---------- -------------_--- ---------------------------------------------------------------------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations----------- ---- - -----.------------- -------- ------------------------------------------------•--•-•------------.---- <br /> ------------ -------------- --- -------------------------------- --------------------------------------------------------------------- ----- ---•------- ------------------------•---------•--------•-----•-•--•-••---- <br /> ---------- ------ ---------------------------------------------------------- ----------------------------------------------------------- --------------------------- <br /> ------------ ---------------------------------------- --•-------- ---- --------•------------------- <br /> ................. . . -- . ------......--------- -- --- --- ------------------------------------------- ---------------------------------------------------------/------- --••-----••------------•-- <br /> FINAL INSPECTION BY:. ..... /� - /�� Date------- -- �- [ ---------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore street 205 West 9th Street <br /> Stockton California Lodi California Manteca,California <br /> , Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br />