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FOR OFFICE USE: <br /> ---------- ------ --- - -------- _ - APPLICATION FOR SANITATION PERMIT Permit No. .....:..........; <br /> �1 z. V / <br /> --------------- - � (Complete in Duplicate) <br /> Date Issued -_.____ _ U <br /> ----.--- .._.._;______________ This Permit Ex fres 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 compliance-with County Ordinance No. 549.,,,:, <br /> a JOB ADDRESS AND LOCATION_��`7 __ -> 72c'gs--`= '� S i.� Se • _ 'y <br /> �- ------------------------ <br /> . - �T <br /> r <br /> Owner's Name---------------------------------------------- � - - -------- ---------------- :_ -' -Phone STC! - LCL. <br /> lAddress-------------------------------------------------------------- ----------------------------------------------------- <br /> ------Tc� ---------------- <br /> Contractor's <br /> -------------------------- ----- - <br /> Contractor's Name----------------------------------�-.t_ ✓------:.---__._------ --•--- Phone..... ---........- <br /> Installation will serve: Residence A artmenf House Commercial Trailer Court Motel Other <br /> Number of living.units: ___I___ Number of bedrooms ❑ i ❑ ❑ ❑ <br /> A. _ <br /> g. _. Number of-- ._Lot;size '---•--c-�--Q--�--��f•--•-•-•-------------- <br /> Water Supply: Public system-N( Community system ❑ Private ❑ Depth to Water Table .y; ''ft. <br /> Character of soil 6"a depth of 3 feet: Sand ❑ Gravel'[] Sandy Loam'0;- Clay Loam ❑ Clay ❑ 'Adobe[R Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------J _No.j�'- New Construction: Yes g No 0 FHA/VA: Yes ❑ No <br /> I TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> '(No septic tank or cesspool permitted if public sewer is available within 200 feet.] <br /> :. t <br /> I Sep�tic, Tank: t Distance from well---A6�%5Distance from fi oundartion._ 40......Material-- <br /> -C <br /> No. of compartments--------,�------------ Liquid <br /> depth----------'y------------CapacitY---FZC�--- <br /> Disposal Field: Distance fror!5 nearest 'well_ -_1/Y '-Distance from found tion---=f-n ``-`:Distance to nearest lot I fe---S._-_.._.. <br /> �] Number of lines________________ _________________Length of each line � !6,4Width of french--------P______________________ <br /> ' Type of filter material___._T�c1�- Depth of filter material--- Total length---------L- - 7f___________________ <br /> Seepage Pit: Distance to nearest well--- ._Distance from foundation:---/_d...._.......Dis�ancq to nearest loft line------_✓`_.___-- <br /> ' tII Number of pits.________________Lining material__ v ----.Size: Diameter-----11.-X6_a'7�3epth:_.____.__-C, ------------- <br /> 1-/,K <br /> -..__._____- ` <br /> t_b p ; it { a <br /> '`Cess ool: Distance from nearest well-----------------Distance from foundstion----�'----------Lining material._____.____._____..___.___._______. <br /> 1❑ Slze. Diameter. -------- -- De th. _ ' <br /> Liquid Capacity ...-.. ---..gals. <br /> st <br /> Privy: hi` � Distance from nearest well-------------------------------------------------Distance from nearest building--------•--•--------•---------------- --.. <br /> Distance to nearest lot line--------------------------- <br /> Remodeling and/or repairing (describe) _-__•-__-_______•_-.-____________._. <br /> •------------------------------------------' ----,.._ <br /> r t i <br /> -----------------------------------------_-------------...-----'-----------------------------------------------------------.------- <br /> ------------------------------------------------------------------'------------------------------------------------------_--------------------••----•-------•---- . <br /> I hereby certify that ['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 /> 1' (Signed)---f ✓ `�` _ (Owner and/or Contractor( <br /> �..-� --_----� :-.- <br /> By:----------------------{_-------------------------------------------------------------------------------------------------------------(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 DEPART MEkT USE ONLY <br /> APPLICATION ACCEPTED BY---- �t '� =-------------------------------------- DATE---------� a �f <br /> REVIEWEDBY------------------------------------- ----------------------------------------------------- DATE---------------------------------------------------....------- <br /> BUILDING ; ERMIT ISSUED------=-------------------------------------------------------—---------------- ------I---- '-----.._-•'DATE------ ---------------------------------------------•-------- <br /> AlterattionAnd/or recommendations: ----------- ------ --------•--•-------- -------------=--------------------------------•-----•--------------------------------. _ <br /> ._-_--_.__.___ <br /> __________________ ____________________ _ _ __.____ ___... --------------.--_-_ __..__..._._`__ ------ <br /> _ <br /> ...- <br /> �0 s / <br /> ------------------•-- --- -.. ..-•- -------- <br /> --------------------------------=--------------------------------------------- --------------------------------------- (/ --------------(/-------------------------------------------------------------------------- <br /> ll <br /> �� CJ <br /> FINAL INSPECTION BY--------------- ------ -------- -----------------'---+-------- Date-------------------------------..-------•--------------------------------- <br /> S <br /> ----------- <br /> SAN JOAQ I•LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9Th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,Californlo <br /> 1(� E8.9'�R Ev16 E0 6.49 F.P.C[I.ZM 8.6a - <br /> I <br />