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FOR OFFICE USE: <br /> L-_ <br /> ---- <br /> __ -- - '> APPLICATION FOR SANITATION PERMIT Permit No. -!_3. .1.. .... <br />--- ------�--------'---_-�r /�, r�`�U (Complete in Duplicate) 7 (� <br /> r ti____r yThis Permit Expires 1 Year From Date Issued Date Issued ___ __`._____l <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 complia c with County Ordinance No. 549 <br /> JOB ADDRESS AND RTIC) '= i <br /> Owner's Name == y ---- P <br /> hone----------------------------- <br /> - <br /> �� -.. • <br /> ...-.... <br /> Address-----•---- � --- ---------------Contractor's Name____________�__:1 ����--T- ---�-4----------------------------•-----------•--------N------ Phone___________________________________ <br /> Ins+aIle+ion <br /> II <br /> will serve: Residence �Apartm6nt House#❑ Commercial ❑ Trailer Court ❑ Motel [:1 Other ❑ I+1111 <br /> Number of living units: __�___ Number edrooms _�_ Number of baths __�--- Lot size __ - --�1• -------------________________ <br /> i� t <br /> Water Supply: Public system Er"Commu nit system E] Private E] Depth to Water Table . ft} <br /> Character of soil to a depth of 3 feet: :Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 991"THardpan ❑ <br /> Previous Application Made: (If yes,date_ _:_-�--------------) No � New Construction: Yes �o ❑I FHA/VA: Yes o ❑ <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___:'--------Distan e dam foundation__-_/4 -------Matial---------.r __ /'` -__-_.. <br /> No. of compartments!__1 __ ______________Size. r q p <br /> - X Liquid de th---���, ----------Capacity-- ve:�_-.1 <br /> .. f —� <br /> DisposalField: Distance from nearest well.-.'___�___-_-Distance from foundation____-Z�_ .Distance to nearest lot l ne__�__________ <br /> Number of lines........ '_._-. Length of each line.... ______:_`__.-.Width of trench _ ____________________ <br /> Type of filter material: 1 a_ -+__Depth of filter material---Z�_---------Total length_______ ________________ <br /> ------= <br /> Seepage Pit: Distance to nearest -------Distance fr m-foun <br /> well ----------- dation-.,� __:___-.Distance to nearest lot line'-0----------- <br /> Size: Diameter-__ __ \ <br /> Number of pits__-___1°'__:_______.Lining material__ �_�__ + + .-.___.Depth__- t�"___�N�C.� <br /> _V <br /> Cesspool: Distance from nearest well------------------Distance from foundation_------------.__..Lining maferial-------------------------------------- <br /> F Diameter------ --Depth - --- -------------Li Liquid Capacity <br /> ❑ �,� --=---------- p - - --------- 9 -----=------------------•---gals. <br /> k\ <br /> Privy: Distance from neared' "ll_________________________---____-___________-_Distance from nearest building--___-________-___________________-_-..._ <br /> ❑ Distance to nearest lot line-- --- ---------------------------- -------------- ---------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe) _ •"` ------ •-------------------- <br /> .....................------------------ --•--- --------•-------------------------------------------------------------------------- <br /> -•---------------------------- <br /> I <br /> ----- --------------------------------------------------=---- <br /> I hereby certify that l have prepared this application and`+hat the work will be done in accordance with San Joaquin Coun <br /> ordinances, State laws, and rules'and regulations of the San Joaquin Local Health District. <br /> f_ <br /> St ned a r Contractor <br /> ( ig )------------- ------ - ;(� ) <br /> B . t ( e)__-_ `/��'° j_._-_______________________ <br /> -� itl <br /> (Plot plan, showing size of lot, location of sys in relation to wells, buildings, etc., can be placed on reverse side). <br /> { FOR-DEPATMENT USE-ONLY---—____� <br /> APPLICATION ACCEPTED BY----- ---------------=------------------------- DATE--------- ------------------------ <br /> REVIEWED BY ------- - -- ---------------------------------•---------------------- QATE. <br /> BUILDINGPERMIT ISSUED--------------------------------------------------------------------------- ­------- ------------ DATE---------------------------------------•-=------------------- <br /> Alterations and/or reto mendatians:_- '____ ____________________ _ <br /> -------------------------------------------------------- <br /> -, = _ ` 1 -------------------------------------------------------- <br /> •-•--------------------------------------------------------------------------------------------- -------- ---------------------------------------------- ---------------------- -------------•-•••----•-••-- <br /> ----------------------------------------------------------------- -------------------------------------•---- •---------------------•---------------------------------•-•--•---.------..--------------------------- <br /> FINAL INSPECTION 'BY:. C ' - --. Date ~ <br /> S' N JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Qak'Street,. q� "moi 1'24.Sy amore Street 205 West 9th St <br /> EW <br /> Stockton,California Lodi,California Mantecc,&lifornia Tracy,C*MWFWF <br /> • <br /> E6.9 REVISED H'J59 F.P.0 CI.ZM 6-6 C1 <br /> .2• <br />