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FOR OFFICE USE: ' <br /> -------------- -� <br /> ' APPLICATION FOR SANITATION PERMIT Permit No. ...� { <br /> k <br /> { (Complete in Duplicate) / <br /> --- This Permit Expires i Year From Date Issued Date Issued _ -, .b� <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install th w rk herein escrib d, <br /> This application is made in compliance with County Ordinance No. 549. � �� �, <br /> JOB ADDRESS AND LOCATION___f_ 11 ...._ ._F. <br /> Owner's Name---------- f ' f�I_C` ...... /` '----------------------------- <br /> ; ---- - ----------------------------------- -- Phone------------------------------------ <br /> /Address--------f` ��t ------'<� ���s—17 - <br /> ` ------------------------- - - --- <br /> Contra�^tors` Nbme------------------- ,0{ '" +r" � - ------------------------------------------- ------ Phone----------------------------------- <br /> Installation will serve: Residence ❑ Apartment House E] Commercial E] Trailer Court L] Motel E] Other <br /> Number of living units: -777- Number of bedrooms _."` Number of baths -4,-_ Lot size .-__-...._-._-.--.- <br /> Water Supply: Public system ❑ Communitysystem Private <br /> y ❑ Depth to Water Table Z9 ff. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ' Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑� i <br /> Previous Application Made: (if yes,date....................) No 0-"''New Construction: Yes [�J'No ❑ FHA/VA: Yes ❑ No ��• i <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_ jP <br /> ....-... M a�qrl /` i _____________ <br /> No. of compartments- _o2................. Liquid depth-_�...4�....-.- <br /> ------- Capacity/,r��. <br /> Disposal Field: Distance from nearest well/_4�.-.Distance from foundation-z'0....------Distance to nearest lot line,`o--._.... <br /> ! <br /> Number of lines...._..A__ __e <br /> _ Length of each line ,� <br /> - g �-� -- -�---- .Width of trench.--'----.----'----'-- ----'--- <br /> Type of{filter of filter material-'e- ________ Total length_ _'_0_.2zQ---.-- <br /> Seepage Pit: Distance to nearest well.. . ...Distance fr m foudation-_.�.4-------Distance to nearest lot line__ ---------- <br /> Number of pits-A- -,-__ -.----..Lining material .Size: Diameter__. �� <br /> Cesspool: Distanc from nearest well-----------------Distance from foundation-__................Lining material------------------------ <br /> __--.--------- <br /> ❑ Size: Diameter------------------ ----- - ----- ----Depth---------------=----------------- - --------'-------Liquid Capacity---.------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------.---------------------------------- <br /> ❑ Distance to nearest lot line- --------------- ----------- ----s--------------------------------- --------- ----------------------------------------------- ' <br /> ' � �f� <br /> Remodeling and/or repairing {descr be) � .Cf- ------ <br /> •� � <br /> ------------------- x -------------------- <br /> WWI <br /> -------------41!'_+r____.---'- -- - - - ----- - -------------- -----• - - ---------69-6---i-----------------------------------------------'- <br /> -------------------------------------'----------------------------------------------------------az-------------------------------------------------------------;--------------------------------- --------------- - ------------ <br /> I <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) '; = r ------------------------ ---- ------(Owner and/or Contractor) <br /> y <br /> ( I <br /> BY Ti+le--------------------------------------- -------------- --------- <br /> (Plot plan, showing size of�lot, location of system i ation to wells, buildings, etc., can be placed on reverse side). <br /> •� f <br /> i ( FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------- .------------------------------------------------------------- DATE-------- <br /> RREVIEWED BY------------------------------------------------------------------------------------------------ -----•----------------------- DATE <br /> BUILDING PERMIT ISSUED------------------------ --- - - ----------'------- - ---------- DATE------------------------------- -------- -------------------- : <br /> Alterations and/or recommendations:_ ------ (�- � 'fir` •r-- --- ------------------•----------•---- ' <br /> ---------------------------------------- ---------------------------------------- -------- ---------- ----------------------------------------------------• --­­--------------------------------------------------- <br /> --------------------------------------------•--------------------------------------------•---•------------------------------- -------'-------------------•------------ ------------------------------------------- <br /> FINAL INSPECTION BY:-----.__._. 7 ------------------------- <br /> -. ' " Date <br /> r <br /> SAN JOAQUIN..LOCAL HEALTH..DISTRICT <br /> 1401 E.Hazelton Ave. 300 West Oak Street .124 Sycamore\'Street �, , 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.C . <br /> ' r <br />