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FOR OFFICE USE: <br /> r-. t <br /> ---------- ---- ------ ------------------------- <br /> _.._--------------- APPLICATION- OR SANITATION PERMIT Permit No_ _______________________ <br /> ----------- -------------------------- --- -------- (Complete in Duplicate) <br /> ' Date Issued .1�--J---------- <br /> This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOBADDRESS AND LOCATION..../W/ ------ � C� -----•-- ------------------------------------------------------------------------------------------- <br /> Owner*s - Phone t <br /> ------•----------- <br /> Address---------4-�-�--3 -----W__A '" -------------------------------••---------------------------- •--•---_--------------.----- <br /> Contractor's Name---1 ......../0-,...... - --•------------------------------------------------------------- -------------------•---- Phone.----•.--------•--•---------------- t <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -Number of bedrooms -A-_ Number of baths _f-_ Lot size -��_,, - -------------•--------•• <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table OP-it. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe g]-hardpan ❑ <br /> Previous Application Made: (lf yes,dclte-------------- ---) No New Construction: Yes W?"No ❑ FHA/VA: Yes Z?—,No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within.200 feet.) <br /> t dal-- - f_C ------------- <br /> Septic Tank: Distance from nearest well___�"�______Distante f om �0--------Ma <br /> foundation___ ��__-- <br /> No. of compartments---- ---------- ---- Size ____ - ---Liquid depth- ---------------Capacity_ ------ <br /> < — .0 <br /> Field: Distance from nearest well.- -.-Distance from foundation-Ze----_---.-_Distance to nearest lot line_ .... <br /> Number of lines-.-.-,1_-_----- Length of each kne_,F�_''e--___ Width of trench �-`------------------------ <br /> Type of filter materia� /� Depth of filter material__ _._-----Total length---. `�------------------- <br /> JY <br /> r *1 s >� <br /> Seepage Pit: Distance to nearest well--------.-.__----Distance frow m foundation--_ a----_--.Distance to nearest lot line_+7------- <br /> Number of pits---l--------------Lining material. - k _- Size: Diameter_-_713-_- Depth,-? <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining mai-eriaL...--._.._.--.--*_----..._--__-__-_ <br /> ❑ 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)------ - -e7 --- --�'•�---,�- --'�--��-�-- ----------�-1--------------------------- ----------- <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)----------------------------- : ----------- --- --------------------- -------------------------{ ontractor) <br /> By: ---------------------------------------------------5i4lation <br /> --- -----------------------(Title)---ew� �- ------- <br /> (Plot plan, showing size of lot;location of system to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------- ------- -- ------------------- DATE------------11�°----------------- <br /> REVIEWEDBY----------------------------------------- --- ------------------------------- ----------------------=----------------------.. DATE-•-----------------•-------------------------------- ------ <br /> BUILDINGPERMIT ISSUED------------------ =-------------------------------------------------- ---------------------------- DATE---------------------------------------------- -------------- <br /> Alterations and/or recommendations---------------------------------------------- - --- ------------------ <br /> -------_ <br /> V- _ ______________ �1 _________ ----------------------------------------------------- <br /> r---- ---------------- - <br /> FINALINSPECTION BY----------------- ---•- ------------------ --------y------------ 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 Tracy,California <br /> J <br />