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7 <br /> FOR OFFICE USE: A, <br />----------------- ---- --- -- --------------------- <br /> APPLVCATION FOR SANITATION PERMIT Permit No. <br /> lot <br /> .............. <br /> ---------- ----- ----------- ------------- <br /> ---------------------- -- -------- (Complete-in Duplicate) <br /> This Permit Expires I Year From Date Issued Date Issued <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 compliance with County Ordinance No. 549, <br /> JOB ADDRESS AND LOCATION_--- Xal -.1c----------a., ------------------------------------ <br /> -------------------------:-------- <br /> Owner's Name------------dax-vv------oxs-ew------------------------I------------ ------ ----- --------­--------------_------------- Phone---------------- ------- ----------- <br /> Address------------------------------------- e-—------------------------------------- ---------------------------------------------------------- -- --------- - -------------------------------- <br /> _. -/ <br /> Contractor's Name ----- /plea( mi......e!21yX7; 40 <br /> ------- ---- -- - ------------------•-----------------... Phone------ ------- ------------_------ <br /> Installation will serve: Residence E] Apartment House [] Commercial [] Trailer Court E] Motel E] Of her <br /> Number of living units: -- ----- Number of bedrooms -------- Number of baths.__---- Lot sizeir,44.0'. --- --------- <br /> Water Supply: Public system El Community system E] Private;K Depth to Water Table ft <br /> Character of soil to a depth of 3 feet- Sand E] Gravel X Sandy Loam 0 Clay Loam [:] Clay)d Adobe D Hardpan 0 <br /> Previous Application Made: (if yes,date_------- -------- - ) No [I New Construction: Yes E] No E] FHA/VA: Yes ❑ No 0 <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-AM-h-Distance from foundation------------------ Mate�al ------6 Al e4f,95�-7e-- <br /> ---------------------------------------- <br /> No. of compartments-__ .. ---------------Size---4eX---ff/�j --Liquid clep�h-----#_ __(0-------Capacity--- ce^ <br /> X <br /> Disposal Field: Distance from nearest well - _A00-/bisfance from foundation 149 Distance to nearest lot line---- trench-_--.x- <br /> V---------- <br /> 44- <br /> Number of lines----------- I-----------------Lfnqfh of each line...--.-. ___-...Width of trench----.x- -----kv-4---------- <br /> -- <br /> Type of filter material._._-7o*Phe_A_4fr�fh of filter material--f _741.......Total length.--__.'!,O_ --------- <br /> ----------- <br /> Seepage Pit: Distance to nearest well_ ------'Distance from foundation----------- ----------Distance to nearest lot Ii.ne-------------------- <br /> . Diameter---_.- ------- - <br /> F1 Number of pits--- ------------..-.--Lining material---------------------- Size: amefer------------------------Depth----------. <br /> Cesspool: Distance from nearest well ................Distance from foundation....----_-.-..-_. . Lining material--.._..-----._.----..-..._.--_-_._.. <br /> ❑ <br /> aterial-------------------------------------- <br /> El Size: Diameter- --- --- -7 <br /> ------------- -------- -------Depfh---' ------­­----------------------Liquid Capacity_-------------------------•galsl <br /> Privy: Distance from nearest well--------------------------------j.-.:-.-.------{Distance from nearest building-----_-.----_-..--__._ ------ <br /> 0 Distance-to nearest lot line ------------­---------M� ----------------- ---- <br /> ------------;-- - ----4------------------------------------------------------------- <br /> -�7 <br /> Remodel jiDand/or repairing (d cribe)- . ......... -- ---- ------------ --- ---------- -------------------_ .. ------------------------- <br /> ------------ - ---------------------------------m-----------------: ----------- --- - <br /> ------------- <br /> -------------------------------------------------------- <br /> ---------------------------------------------- -------------------------------- -------- --------------------------------- <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 Vlws, and rules and regulations of the Sa quin Local Health District. 4 <br /> Xd� %G <br /> ------------------- ----------------------- -------------------------(Owner and/or Contractor) <br /> (Signed]_ ----- --------- <br /> By:----------------------- ------------------------------------------ - - --------- -------------------------- -Jitle)_------ ....................... ....... ..._.............. <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED B -------------------------------- -------------- DATE ------------------------ <br /> /--- -- ------- ----------- <br /> REVIEWED BY--------------------------------------------- -..... ... - ------------- - --- ---------------------------------- DATE----- -------- <br /> - ------------------------------------------- <br /> BUILDINGPERMIT ISSUED.------- -- --------------------------- ------------------------- ------------------------ DA-TE---- -------------------- -- ------ -_------------------- <br /> Alterations and/or recommendations: - ------------------------------ ---------- - ---------------- ---------------------------------------------------- --- ------------------------------- <br /> ------ -------------------- --------- - --------------------------- ----------------------- ------ -- ------- - -------- - ----------------- -------------------- ----------------------------------------------------- <br /> --------------------------------- ---------------------------------__---- ------ - ---------------------------------------------------- ------------------------------------------------------------------------ -------- <br /> -------------------------- ................... ------ ---------------------------------- ---------------------- -------------------------------------------- - ­­­ ................................. <br /> ............. ...... --- ---------------------------------r...... ---- -...-------•-------=--.........---- ------- ----•---------- ---------- -------- <br /> FINAL INSPECTION BY:.... Ale Date/# 0; <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycam are Street 205 West 91h Street <br /> Stockton,California Lad!. California Manteca, California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />