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PFe"F- <br /> FOR OFFICE USE: t <br /> a --------��- _.. I APPLICATION FOR SANITATION PERMIT Permit No. ... - <br /> Q P- <br /> I ��� (Complete in Duplicate) <br /> -------------------------- - - 1f-i� = Date issued / <br /> _---------------•-- ---- �� This Permit Expires 1 Year From Date Issued <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 copliance with County Ordinance No. S49. <br /> JOB ADDRESS AND LOCATIP ______czf_1__- -------- -• - --- <br /> Owner's Name---------`S I ....-� 4��- r-------------- -------------------- Phone <br /> r r <br /> Address. = f��' - 17 -- ••----------- l.�lr� " <br /> ��y <br /> Contractor's,Name-------------- /� �� --------------- ----- --- ----------------- Phone----------------------------------- <br /> Installation will serve: Reside��e Apartment House El Commercial F] Trailer Court ❑ Motel ❑ Other C] <br /> Number of living units: 11/.- Number of bedrooms _/--.- Number of baths __ -- Lot size _-!00ok-Q_ ------------------------•----------- <br /> Water Supply: Public system s❑ Community system ❑ Private ❑ Depth to Water Table &-- ft. <br /> Character of soil to a depth of feet: Sand ❑ Gravel E] Sandy Loam El Clay Loam El Clay E] Adobe �-lardpan El <br /> Previous Application Made: (I,fi yes,date--------------------) No ®,New Construction: Yes E] No ®SHA/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 /> tSeptic Tank:. Distance f om nearest well-----------------Distance from foundation--------------------Material------------------------------------------------- <br /> o91114 f No. of compartments--------------------------Size--------------------------------Liquid depth--- ----------------------Capacity--------- ------------- <br /> Disp°sal Fieldy Distance'from nearest weEl-___.-_--___---_Distance from foundation____---_-____----Distance to nearest lot line----------------- <br /> 6.0 sal <br /> Number of lines--------------------------------_Length of each line-----------------------------Width of trench-- ---------- ------ <br /> Type of filter material------------------------ Depth of filter material-----___--_----_`_-Total length_-______--_----____-_-_----_______-__-- <br /> Seepage Pit: Distance t' nearest'well----------------------Distance fr m fo ndation__`�...___--.Distance to nearest e�lot�iine__� -r..-_ <br /> Number oil pits----,�--------------Lining material_� '`' __Size: Diameter-_, .3 _. Depth +_.,--- - "_. <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--.--_-_--_-_-----_____---_--___ <br /> ❑ Size: Diameter------ ----------------------_------Depth--------------------- ------------- - ----------:--Liquid Capacity--------------- gals. <br /> Privy: Distance from nearest well __________---------------------------------------Distance from nearest building-----.-.---_---___ <br /> ❑ Distance to nearest lot line------------ • - - <br /> ------------ -------------------- -- <br /> ----- --------------- -------------- --------------------------------------------------- <br /> - - <br /> 1; • <br /> Remodeling and/or repairing'(describe)-------- ---- -- -- <br /> - - "'Ir ---- - -------- ---------------------------------------------------- <br /> I: --------------------------------------- ------ <br /> ------------------------------------------ ------------------------------------------------- <br /> ,I <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 SanC/Joaquin Local Health District. <br /> -I(Signed) ----`-�-- ' <br /> -------------- -------- ------------------- - ---445jn5331ZeajjWor Contractor} <br /> By:----------- ----------------------------------------------- (Title}_ ------------ <br /> (Plot plan, showing size of lot location of system in re n to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY / <br /> APPLICATION ACCEPTED BY---____-- DATE---_-- - �P-- -------------------------- <br /> REVIEWEDBY------------------------Ir--------- -- -------------------------------------- ------------------------------------------------ DATE------ -----------------------------------•---------------- <br /> BUILDINGPERMIT. ISSUED-A---------- -------------------------------------------------------------------------------------- DATE------------------------------------------------ ----------- <br /> Alterations and/or recommendations:----------------- - -------- -------- ------------------------------------------ -------------------•--•---------------•------ -----------------•-------- <br /> -------------'-------------------------------------------------------------------- ---------------------------------------------------------- <br /> - I <br /> -- <br /> -� If <br /> -------------------------------------------------I------------------------------- ----------- -----------------------------------------------­­ <br /> -------------------------------------------------------- -------- -------------------------- <br /> ----------•------ - <br /> - ------ - ---------------------- ---------------- <br /> - ---- -- ------ ----- <br /> ------ - G�:-------------------------- -------------- Date----------. Y_l�-.��.-� ------------------------ <br /> ----------------- <br /> FINAL INSPECTION SY:-__�'-.-._ <br /> 4 SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ti <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.CO, <br />