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FOR OFFICE USE: <br />--------------.:---_.-_-"_--__---_.---.----..----.---- APPLICATION FOR SANITATION PERMIT Permit No. ___ ... ...�.__.. <br /> f' 1s <br /> (Complete in Duplicate) <br /> This Permit Expires 1 Year From Date Issued s Data IssuedI AA <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 Or •n ce No. 549. <br /> JOB ADDRESS AND LOCATION... �7 .------------------------------------------------------trJ cry I .tl �!t '+a R hW,4c <br /> Owner's Name_--.K�/0__y ----------TQ-91_G 4--7--7__------ Phone. <br /> ---------------------------- - - - ------------------------------------- ------ <br /> Address-------N97-----,1 _AR-. ��-s" ' r`. f1Al--�'afiR !_ �►-------------------------------------------------------------------- <br /> Contractor's -------•--•---------------------------------------------------------------------------- •-------------------- Phone----.-3^_.-I- -------- <br /> Installation will serve: Residence°e--<partment House ❑ /Commercial [-] Trailer Court El Motel [IOth r ❑ <br /> Number of living units: __.�_-_ Number of bedrooms ---/._ Number o baths I-.-- Lot size ___-- ._ _.-. ---------------------- <br /> Water Supply: Public system ❑ Community system [I Private j�epth to Water Table --q- €t. <br /> Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date_..-.- - --------) No P,"'New Construction: Yes ❑ No 0,/FHA/VA: Yes ❑ No 0% <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:— J <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> n <br /> Septic 104. Distance from nearest well-_6V--_---Distance from foundation---/P----------.Material---_._..__..n fJf C- <br /> 01, No. of compartments.....9--------------- ------------Liquid depth-_.-__�4-`�..---------Capacity.....ML49!---_ <br /> Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line--------_--.----- <br /> ❑ Number of lines-----------------------------------Length of each line-----------------------------Width of french------------------------------------ <br /> Type of filter material-------------------------Depth of filter material----------------------- length--_---_--_-_--------_-__--_--_------.--__ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- <br /> 0 Number of pits----------------------Lining material-----------------------Size: Diameter------.----------------Depth--------..._-------------._--- <br /> Cesspool: Distance from nearest well---------------_Distance from foundation.-------------------Lining material---------------__--_---_. <br /> ------------- <br /> ❑ Size: Diameter----- ------- ----------Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------.-----------------Distance from nearest building..-.-.----------._-_----------_--.._----.. <br /> ❑ Distance to nearest lot lire-- ----------------------------- -------------------------- -------------------------------------------------------------------- <br /> Remodeling and or rep 'ring [describe)• __ ___ _ __ _ __________________ - - --- ---------------- <br /> A! <br /> y. ,��--��---,r���= . jt! <br /> 'a � <br /> �er`.�,��__._�,�.a--.-,T,� �,��'-G�����2 �n�-------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <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)----------------------------------------- ---- - _ —__ __---------------- ---- _-:(Owner and/a&.ir.�w4or)' <br /> sY= ----�(Title)---10'L ,11✓ '------- ------- <br /> By.- <br /> (Plot <br /> ------ <br /> (Plot plan, showing txe INZ <br /> of lot, location of system in relation tow s, buildings, etc., can be placed on reverse side}. <br /> FORD ARTMENT USE ONLY <br /> APPLICATION ACCEPTED BYi v�'------- ----------------------------------------------------------- DATE-------- -` L "`� ' <br /> ---- <br /> REVIEWEDBY---------------------------------------------------------------------------------- ------------------------------ DATE---- ------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------- - --- DATE----------------------------- -----------_----------------- <br /> Alterations and/or recommendations:--- :---.---5 ( iz lr� -----__-- - --'--_ ---------------------•--------------------------------------- <br /> ------------------------------------------------•--------------- �-------._.- ---------- ---------------------------------•----------------•--- ---------- <br /> Pt.t r_ 1 --------------------- �-�-�---__ _____----F« ._---.--F0M __- mo_V__ <br /> -r es -rf .�4 Q-...._.._9 .......1 nr sR_M ------- .o 4A =��N--------------------------------- -------------- <br /> ----- - ---- - ---- - - -------------- - ---- - ----------------- ---- ------------ <br /> --------------------------------------- -- <br /> ----------I-------------------------- <br /> FINAL INSPECTIO1�JC _ .. y �z�� - Date.-- <br /> = ------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P-CO. <br />