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FOR OFFICE USE- <br /> ----------------- <br /> SE.---_----.--..-. .--.I f��5�i. -------- <br /> r--- --2 APPLICATION FOR SANITATION PERMIT Permit No. __ .�__.. <br />--------------------------------------- ---------------- (Complete in Duplicate) f/ <br />.-----------------------------------------.------.---.--. This Permit Expires 1 Year From Date Issued <br /> Date issued .............?Z,,l?� <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 Ordinance Igo. 549. <br /> JOB ADDRESS AND LOCATION_.__Lq__(4 --=---------- J-------- <br /> Owner's Name----- 4 - -- - -- -C - --------------------------------------- Phone...�.�C <br /> Address....... �! -C .... <br /> Contractor's Name.... ---.L- ----�7��-------•-•-----•-----------------------------------------------•----__---- Phone................................ <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court [Motel ❑� Other ❑� <br /> Number of living units: _7__ mbar of bedrooms : 7. Number of baths ..7... Lot size ..... .t_ .___x__._[_ ............:.. <br /> _ <br /> Water Supply: Public system Community system ❑ -Private ❑ Depth to Water Table 1.0ft. <br /> Character of soil to a depth of 3 feet:,'Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay dobe❑ Hardpan ❑ ` <br /> Previous Application Made: (If yes,date__n=s ____1 No ❑ New Construction: Yes [3--'Ko ❑ 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--f Distance from foun tion_-_ Material_ T_ � ..G1t �x.. <br /> No. of compartments----_---- --------------Slze__�7 cld-,ll�-- uid depth__`_-3---^-----Capacity... <br /> Disposal Field: Distance from nearest well__._.... Distance from foundation.._-�-.Distance to nearest lot line.... �.... <br /> ® <br /> -----Len 7��Length of each line4-0" € ��, Number of lines-'- --------------------- 9 -a-- --:�--�- -.• ..Width of +ranch....---•�-�'--------------� <br /> Type of filter matari8l._. �l_C i Depth of filter material__._4q.R........_Total length----_- ,`__.� <br /> Seepage Pit: Distance to nearest well-------Distance from tounclation___—stance to nearest lot line......imp <br /> 0 Number of pits-_-_------�---_Lining material-------Size: Diameter__. _ ".._...Depth.....'_-7-,5- <br /> ------­-------- <br /> Cesspool: <br /> -7-, ________________Cesspool: 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----------..._...R. . <br /> -•---------------- <br /> ❑ Distance to nearest lot line---------------------------------------------- --•----•-•......... <br /> .. :.. <br /> Remodelingand/or repairing (describe);---------------------------------------------------------------------------------------------------------------------------------_--•----------------- <br /> .. •--- -------------------------------------------•-•-•----------------------••---------------•-------------••---------------------•-------•----- <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)---------------------- 4 (Owner and/or Contractor) <br /> rrr <br /> `n .•-•-----.-• Title---------- -------------- -- ------ <br /> (Plot plan, showing size of lot, location of system in relation + ells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-_,)----- ---- ---------- ------- -=--------------------------------------- DATE--J ' <br /> REVIEWEDBY------- ----------------------------------I----=---------------------------------------------------------------------------- DATE----------------------...----------------------------------. <br /> BUILDING PERMIT ISSUED-----------------------------------------------•-••--•---------------------------------------------- DATE------ ...... <br /> Alt,ratisand/or recammenda ions --- _ -----------------------------_ __ -------------------- ---------------------- <br /> I <br /> Qom- _ t ' � <br /> -�_ ------ --------Lr 1 �� .- .tee_ r. ... <br /> -------------- � ��-`- -•-e,-.' p �' _ ----I----- <br /> FINAL INSPECTION $Y:..._ �. rte- Date /�{ - ----------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Srrest 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-S9 2W 5-61 ASLAS <br />