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FQR OFFICE USE <br /> or <br /> ------------------ --- 732-- <br /> APPLICATION FOR SANITATION PERMIT Permit No. _!........ ------- <br /> ---------------- ------------- --------- ----------- <br /> _,a (Complete in <br /> Yl <br /> ---------------- ------ ---------------------------------- Date Issued ------------ <br /> -----------------------------------I------------------ This Permit Expires I Year From Date Issued <br /> " Application is hereby made to the San'Joaquin Local Health District for a permit to construct and install th4 work herein described. <br /> This <br /> application is made in compliance with County Ordinance No. 549. <br /> ----7/0-------- -----------------------------------------•---------------=---------•--------------------- <br /> JOB ADDRESS AND LOCATION -------------------------- <br /> ;W <br /> Owner's Name_,<,- bez ---------------- -------- Phorie------------------------------------ <br /> ------------------------------ <br /> Address------------ Z------- --al-k------ -------- ----------- ------------------- --------------------------­-------------------------- ------------------------------------ <br /> r . . I I - .�e I . ............----------------_-- <br /> Contractor's Name--- ------------ ------------------------------------------------------------------------------------------------ Phone. <br /> e E] Commercial E] Trailer Court 0 Motel 0 Other El <br /> Installation will serve: Residence [! Apartment Hous' <br /> e 70.,X -------------------- <br /> Number of living units: -- ---- Number of bedrooms _Z_.Number of baths.. Lot,size ,//10' <br /> Water Supply: -Public.syOm El. Community system [] Private Depth to Water Tab <br /> Character of soil to a depth of 3 feet: Sand [] Gravel E] Sandy Loa.m El Clay Loam El Clay E] Adobe ft--'Hardpan El <br /> PT <br /> I - I - . No QS <br /> Previous Application Made: (If yes,date---------------------) No PT New Construction: Yes Zj"No E] FHA/VA: Yes E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if publicsewer is available within 200 feet.)-4 <br /> Sepfic,,Tank: <br /> Distance from nearest w4el--1- ----------Distance from foundation__.CU. _.____. ------- ----------- <br /> '-1 <br /> pacity---0--a-0-- ------- <br /> No. of compartme ---- - ------ Size--..,3X;-S-- -- ----- Liquid depth--- .................. Ca <br /> line_________________ <br /> Dislr)osdl 5ieU: Distance from nearest well,570!"-_------.._-'-_.Distance from founclaflon__k�------------Distance to nearest lot - <br /> 0� L I/ <br /> Number of lines--- --------------Length of each line_______ -------------Width of trench_,ZV1----------- -- --------- <br /> ---I- :� ----------- <br /> Type of filter material-- ___-__Depth of filter malerial_/r-------------Total length________` ----------- <br /> Seepage +: Distance to nearest well-/ --------------Distan m f vnclafion__/��-----------Distance to nearest lot line_________________ <br /> Numb <br /> ine----------------- <br /> Numb PC iameter.q,;�_�------- ----Depth-.-Zk)' --------------- <br /> er of pits___ -----------------Lining material__�,W1__M - -----Size: D <br /> Cesspool. Distance from nearest well-'---.-----------Distance from fo�unclation---------------------Lininq material__.___________-_--__.____________._. <br /> ❑ <br /> aterial------------------------------------- <br /> EJ Size: Diameter-------- ----------------- ----------Depth------------------------------------- --------------Liquid Capacity----------------------------gals. <br /> Privy- Distance from nearest well-_____.__.-__________________________________ <br /> --Distance from nearesf.building.----------------------------------------- <br /> Distance to}nearest lot line------ --------- <br /> -------------------------=_ --------------------------------- ------------------------------------------- <br /> Remodeling and/of repairing [describe):------ ------------------- ----------------------------------------------------------------------- ------------------------------------------ <br /> --------------- <br /> ------------------------------------------------------------------------------------------ ---­--------------------------I---------------------------I----------- ------------------------------------------------------- <br /> ---------------------------------------------------- ---------I----------------------------------------------- ----------------------1.1-------I-------------- -------- -- <br /> -- ----------------------------------------- <br /> ---------t�---------------------------------------------------------------------- -------------- <br /> ------------------------------------ ----------------------------------------------------------------------------------------- <br /> I here6y certify that I have prepared +hi application and that the work will be done,in accordance with San Joaquin County <br /> have <br /> ordinances, State laws, and rules and requ , ions f the San Joaquin Local Health District. <br /> (Signed)---------------------------­- --- ------/- -------------- ------------------------- ---- --- ------------------------------------------(Owner and/or Contractorl <br /> ------------ <br /> By:------------------------------------- --- --- ---------------------------------------------------------------- ------------------(Title).---------------__------------------_ -:---- ---------- - <br /> (Plot plan, showing size of lot, location of system in relation to-wells, buildings, etc., can.be placed an reverse side). <br /> � <br /> FORMEPARTMENT USE ONLY-4 <br /> APPLICATIONACCEPTED BY--- -----------------"------------ ,---= DATE------------------------------------------- ---------------- <br /> REVIEWEDBY-------------------------------- ------------------------------------- -----------------------------------------------------•-- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------- DATE----------------------------------------------------------- <br /> Alterationsand/or recomirridiridations::--- ---------------------------------------- -------------------------------------- ----------•-•-----•---......--------------------------------•------------ <br /> --------- ----------------- ------------- ------------------------------------------------------------------------------------------ -------------------------------------------------------------------- <br /> ------------ ----------------------------------------------------- <br /> ------------------ ----- ....... <br /> ---------- ---------------- -- ---- <br /> ----- - ------------- - ------------ --------- ------------------------------------------------------------------------------ <br /> ---------------------- ------------- --------------- ----- <br /> - <br /> ---------- ---------------------------- --------------------------------------------- <br /> --------------------------- ----------------------------------------------------------- -- --- ----------- - ------------ <br /> PINAL INSPECTION BY:----- ---------- Date_ ---------------------- ---------------- <br /> 11n, SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxeltan Ave. 300 West Oak Street 124 Sycamore Street 205 Vest 9th Street <br /> Stockton,California Lodi,California- Manteca,California Tracy,California. <br /> ES 4 gievISED B-59 3M 3-'63 F.P.013. <br />