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F OFFICE USE-,, <br /> -- / G� <br /> 3<J <br /> --- --- -_---I�`_2.9 APPLICATION FOR,SANITATION PERMIT Permi+ No. ._!_. _L_`....__.. <br /> f / I <br /> -------•---------------------• ------- (Com¢lefe'in Duplica+e) <br /> This Permit-Expires 1 Year From Date Issued <br /> Date Issued <br /> ----------------- _-- --�---- --------- <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 No. 549. <br /> JOB ADDRESS AND LOCATION-----------�� �' -�� C r--�r -------- ---- <br /> .--�1! Y <br /> Owner's Name-------------�t-----•------------ -•- -------------------------­-----------------------­................ <br /> Phone.---------------------------------- <br /> Address-------------- ---------- 3----------jam---7------/�7��`f------ ------------------••------------------------------------------•----•--------...-----------•----------•------------- <br /> - �{ � -------------------------- -- ----------•------------------- ------------ Phone----�...�!_�-f-7�r2�7-5ex <br /> Contractor's: Name---------- ------ -_: -----_-___- _�_� <br /> Installation will serve: Residence Zj' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _-/.---_ Number of bedrooms ._2,.- Number of baths --L---- Lot size --- --_PG- 't--------------------------------- <br /> Water Supply: Public,,system ❑ Community system ❑ Private Depth to Water Table --- £t. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe e-- Hardpan ❑ <br /> Previous Application Made: llf yes,date"...................) No Ei— New Construction: Yes ❑ No 9j,— 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.Ta k: Distance from nearest well------------- .---Distance from foundation----.-- -------- Material---------` _ <br /> __ _--.---- ..----- <br /> No. of compartments-l----------------- -----Size----------------- ------ -----Liquid depth.- <br /> . ---------------------�Capacity p'' -------------------- <br /> Disposal Field: Distance from nearest)well.s"J-------Distance from foundation....Z.�----------Distance to nearest lot line._-vr--.-.-_. <br /> I <br /> Number of lines_- ---�_-_ Len th of each line-__-_---s�G)---r-----------Width of trench__ L ------ LAI Type of filter material-----A�-s-A---Depth of filter material----.--�-8-�r_______Total length-,_:---r4- --------------- <br /> k, Seepage Pit: Distance to nearest well-_1n.9--.r------Distance from foundation----Y-e--------- to nearest lot line--4.1;--.-_--_ <br /> [ Number of'pits------ ---=--------Lining material----- --Size: DiaDepth---- _S__^_.�---.- <br /> Cesspool: Distance`frcm nearesf weR-----------------Distance from foundationN-.'------- material---------------------------- Q <br />• ?e� ir _ _ L....�'❑ -A i-gals <br /> th--------------- ----------------------n'� --- Li uid Ca acY ---- <br /> Privy:. Ds a nearest well ------------------------------------------Distance from nearest building -{----.-------------.------. .----_.., <br /> ❑ Distance to nearest o --------- -------- -------------------•----------------------------------------------------------=`-------- --------- <br /> Remodeling and/or repairing (describe):_-___---...........------------------------ ------------------------------------------ k --. <br /> t �. ' I <br /> ------------------------------------------------------ ---------------- ----- <br /> - <br /> i \ <br /> I hereby certify that I have prepared this application and that the workwill'Vi—done jn accordance with San Joaquin County <br /> ordinances, State laws; anrules and regulations off + tr Joaquin Local Health Di +ricf. <br /> F � <br /> ------------------`'------------ {Owner and/or Contractor) <br /> {Signed)------------- i ----- <br /> B ' <br /> Ti+le....... <br /> ------------ <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 ONLYj <br /> e 7Y <br /> v' PPLICATION ACCEPTED BY-.--=------ - I --- DATE � - ` ��-�- .. <br /> . .- kEVIEWED BY------ -----= t , -' = ----- - ---------- DATE------------------------------------------------------------ <br /> B€iILDJNG PERMIT r <br /> ISS <br /> UED----- r �� ---------------------- ---.-. lA -------=---r--_--,--r. <br /> --..------------------•-- -----r- <br /> os 6- t <br /> Altera _ ------ <br /> --------------------------------- ---------------- .---- <br /> - <br /> 4. ' <br /> ------------_.---._-------------------- <br /> --------------------------------------------- ----'----------------------------------------------- ------------------------------------------ <br /> I <br /> ------------------- - --.-- <br /> FINAL ,INSPECTION S : <br /> AN ..---•----'- <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.H6xelton Ave. 0 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> 1 stocklon,California Lodi,California' Manteca,California Tracy,California <br /> V <br />} <br />