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FOR OFFICE USE: <br />- <br />-------------------------------------------------------- APPLICATION P()R SANITATION PERMIT Permit No. ...._--_------•_-_--- <br />---------------------------- --------------------------- (Complete in Duplicate) �/�� w <br />.-.------------------------------------------------------ This Permit Expires 1 Year From Date Issued Date Issued ..../........_..'....__ <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 Oynaa No. 549. _ /� -7 ,�/ / op� ph <br /> JOS ADDRESS AND LOCATI N G -- - ----- '�'` / .... -------------------------------F--�----•----......... <br /> Owner's Name--------.. t/1---- -------- • - - --------------------- Phone.----•--------------------------- <br /> Address. 1 ✓�! •--••-•---... .....................................................•-----------•--•-••--------...-.--------- <br /> Contractor's Name.--- -----•--•-----•----------------------------------------------------------------------------------------•------ Phone................................... <br /> Installation will serve: Residence M Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ----1___ Number of bedrooms __'�._ Number of baths -/..... Lot size ------- ----- 1-11-4 <br /> ----- --- -------------------._.- <br /> Water Supply: Public system ❑ Community system ❑ Private 4 Depth to Water Table q-Q- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [� Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: {lf yes,date-------_---_.---_-) No New Construction: Yes W 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.) �p <br /> Septic Tank: Distance from nearest'well..-X -----Distance from foundation.-.-l-Q------•---Material--- ..... � F/ <br /> No. of com artments-.___ -. j �f <br /> ® P �' - Size �k 'r__. _.Liquid depth----_----- ------Capacity--.1 .}.. <br /> Disposal Field: Distance from nearest well...4- -.----Distance from foundation----1_Q_..-_.....Distance to nearest lot line__.._--..... <br /> Number of lines........ ......•-------------------Length of-each line........a'S-.............Width of french......36.`-------------------- <br /> Type of filter material �� Depth of filter material...11.'! Q - <br /> __-......Total length_._.Z -- -•----------------------- <br /> Seepage Pit: Distance to nearest well---------------------Distance from foundation--------------------Distance to nearest lot line--............... (,11 <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth----------.-_-._.--.----___------ <br /> Cesspool: Distance from nearest well-----------------Distence from foundation--------------------Lining material------------------------------------- <br /> 0 Size: Diameter------------ ----- - ......Depth '---:--_--•---•-... ------------------------Liquid Capacity---------------------------.gals. <br /> Privy- Distance from nearest well----------------------_--_--__--,-.--- -------Distance from nearest building---_-.-..--__-__----_________------.-----. <br /> ❑ Distance to nearest lot line--------- ------------------------------------------------------------------------------------------------------------------------------------ <br /> Remodeling and/or repairing (describe):----------------------------------------------------------------------------------------- ------------------------•---------_........ <br /> m ----. ..--• ------•-------------- - <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, Stat laws, and rules nd regulations of the San Joaquin Local Health District. <br /> (Signed)- .................-------•------------------------------..-..--•------•-------------•--•----------------­---------------------- -----.-(Owner and/or Contractor) �P <br /> By:---------- ---------------------------------...--------------------------------------------------------------------------------•--.(Title)--------------------------...-------------------------------- <br /> {Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY n` <br /> APPLICATION ACCEPTED BY 1 °" ---------------------------------------------- DATE------- ------------------------------------------ <br /> REVIEWED <br /> ----v------------ •REVIEWED BY------------------------------------------------------------------------------------------------------------------------------ DATE-------------------....------------------------------------ <br /> BUILDINGPERMIT ISSUED----------------------- -------------------------------------_------------------------------------- DATE------------------------------------------------------------ <br /> Alterations and/or recommendations:------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------.. •--------.------ <br /> ----•--•----------------------------------------------------------------- --•---•-•----...--------.------------•----------------------------------------------------.----------------------------------------------------- <br /> -------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------•---------------•-------- <br /> FINAL INSPECTION BY: r --------------------- Date......7'2 -1___4-�-- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California VVV <br /> E6 9 nEvlstO 8-59 8M 5-61 ATLAe <br />