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FOR OFFICE USE: <br /> 0ff 7 <br />--------------------------------------------------------- APPLICATION,, FOR,SANITATION PERMIT Permit No. <br />------------------------------ ------------------------- (Complete in Duplicate) <br />_________________________________________________________ This Permit Expires 1 Year From Date Issued <br /> Date Issued ------- ----- --I� <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--f---�jl- - ------- __-- --- - ---�------. -------------- � <br /> Owner's Name------ 4! - -------------------- ---- ------------ Phone------------------------------------ <br /> Address <br /> --------------------- ------ <br /> Address------------ "p-- �----- ��' <br /> - ------ ---------------------------------------------- ------------------------------- <br /> Contractor's Nama - .�. c- --------------------- -- --------- Phone--y� <br /> Installation will serve: Residence [E["Apartment House ❑ ,Commercial E] Trailer Court El Motel E] Other E]Number of living units: _�----- Number of bedrooms 4- . Number of baths __/--- Lot size -:-___- e,ela '�— ------------------------------ <br /> a <br /> Water Supply: Public system-2- Community system 0 Private ❑ Depth to Water Table -------- ft. <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 ®' New Construction: Yes El- No ❑ FHA/VA: Yes Z;.- No ❑ <br /> r <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...45-A.r____Distance from foundation----?_d-----------Material----- ay'zrt' _.___---------- <br /> No. of compartments--------�--------------Size---SY_`'K .`x_�__'_Liquid depth_.._._`---__..._.__.__.Capacity-_/4A <br /> Disposal Field: Distance from nearest well___,SU.-.-.-.Distance from foundation-----/I to nearest lot line_--_s'_-..----_ <br /> v❑' Number of lines------- ice----------(_-_-_Length of each line-------2Q------------------ <br /> Width of french...-Z--------------- ------------ <br /> Type of filter mate ria -----Depth of filter material----- ------- length------ _--------- <br /> See pag at: Distance to nearest _-__Distance from foundation--------t_--__. Distance to nearest lot line----------------- <br /> Number of its_________ <br /> p ____------Lining material----R-''-_t� ­Size: Diameter------- ----Depth-----------r ------ <br /> _ _ <br /> Cesspool: Distance from nearest well-------------- Distance from foundation......--------------Lining <br /> Imaterial_ <br /> _.-..:___._-----.-.-. <br /> ❑ Size: Diameter--------I-----------------------------De th---------------_- _- -------- - _--- Liquid Capacity- ---------- ------r---°-------_-(ga_lsI. L t <br /> Privy: Distance from nearest well------------------------------------------_-------Distance from nearest building------------------------------------------_. <br /> ❑ Distance to nearest lot line------------------------- ------- ----------------------------- ------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe)-------------------------- -- ----------_-------- h <br /> ----------------•----------------•---------------------------------------•--------------------------- ------ ------•----------------------------------------- ------ ----------------------------------------- ---------- <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)------------ ' ---I---------------------------------------------------- ----------------------------------------(Owner and/or Contractor) <br /> By:------------- - - --------------------------------------------------------------------- <br /> - <br /> -------------------------------------(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 'I <br /> APPLICATION ACCEPTED BY-------.--� _,_- ------ ------ DATE------.-,1_G' ._� --------- <br /> REVIEWED <br /> '— " <br /> REVIEWEDBY - --------------------------------=------------------------- DATE........ --------- ----------------------------------------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------ ---------------------- ----------------------- PATE--.-.------.- -----------{------------------------- <br /> Alterations and/or recommendations:-------_} 5' b �~- 3�.I ' { ---- ' - - -z`�. --.'� � ._`=i- <br /> r - --------_cl, - -e.J, <br /> ------.------------------------------------------------------------------------------------------------------------- <br /> -------------------..-----------------------...-. �. <br /> ------------___--------------------__________ _____________________________________________________________________________________----'.C._----._--_-_..__-_-...---.-.-_--_--------_-__.--_--_------------------------------------------------------- <br /> ' <br /> A/ <br /> FINAL INSPECTION BY:.------. Date7 J <br /> S JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxelton Ave. 300 West Oak Street 1;24 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California * ' " Manteca,California Tracy,California <br /> F.R.C o. <br /> y <br />