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FOR OFFICE USE- <br /> -------------------- --- - ------------------------ <br /> 313eAr W 3 (,j APPLICATION FOR SANITATION PERMIT Permit No. <br /> ---------- ---------------------------- <br /> ------------ -------------------------------------------- (Complete in Duplicate) 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 the work herein described. <br /> This application is made in compliance wifh County Ordinance No. 549. <br /> JOB ADDRESS AND L ATI ---------dwww4&�--------i <br /> Owner's Name------ . ........ ----------- ------------------------------------------------------------- Phone------------------------------------ <br /> Address-------- ....... . <br /> - ----- ------------------ --------------------------------------------------------------------------------------------- <br /> Contractor's Name----------- ---- ---------- Phone......----------------------------- <br /> -- ------------------ ---------------=------------------------ ----------------- <br /> Installation will serve: Residence 93"Aparfmant House [] Commercial [] Trailer Court E] Motel ❑ Other, E] <br /> Number of living units: Number of bedrooms J--- Number of baths/----- Lot size - --_'•________________________ <br /> Wafer <br /> - -------------- ---------- <br /> Wafer Supply: Public system El Community systemwal<Ivate E] Depth to Water Table 3'96P ft. <br /> Character of soil to a depth of 3 feet: Sand [_] Gravel L] Sandy Loam E] Clay Loam F] Clay [] Adobe 91--F1'ardpan ID <br /> Previous Applicaf ion Made: (if yes,date-..______.,_____._.) No W?'New Construction: Yes 21--No [:] FHA/VA.. Yes �No [I <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Distance from nearest wel Distance from foundation---- -------------Ma Xial----e-4 eA- <br /> Septic 1pak- ----- M ---------- <br /> No. of compartments____ ---I-------------- ---Liquid depth___ ....r-1..________Capacity__. W------- <br /> 1�r I -_ A71-* - / I <br /> Disposal Field: Distance from nearest well. D istance-f rom--founda-f ion_./P_:-........Distance-�io nearest lot I line---4-------- <br /> Number of lines________elz_. ----- Length of each line___ ---------Width of trench--.,?---------------------------- <br /> Type of filter materiale_�-t�4w�-Depfh of filter material-AP-_*--------Total _---_ <br /> Seepage Pit: Distance to nearest well----—-------Distance f f daf ion----/Z9......Distance to nearest lot line-4- <br /> Number of pifs........ material_WTN�OZ.Size: Diamefer2.4.7 ----------Depth---A07!,',1WAJ(_ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- <br /> F-1 Size: Diameter------------- ------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest wO--- --------------------------------------------Distance from nearest building-----------------------------------------. <br /> ❑ <br /> uilding------------------------------------------ <br /> El Distance to nearest lot-line----------------------------------------------- ------------------ --------------------------------- --------------------- <br /> Remodeling and/or repairing (describe):- ----------- -- .. <br /> ----------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ------------------------------------------------------------------------I--------------------------------------------------_......._.......__--------------------------------------------------------------------------- <br /> ----------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------I----------------------- - <br /> I hereby certify that I have prepar'ed'Ais 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 /> (Signed)------------ ------------------------ ----------------------- - _NWIM""Wor Contractorl <br /> j ___ -ir <br /> --------------------------- -- ----- ------ - ------------- <br /> By:------------------------------------------- - - (Title) <br /> ------ ----- <br /> (Plot plan, showing size of lot, location of syst in relafion to wells, buildings, etc., can be placed on reverse side). <br /> r <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- ---------- DATE-- [c� <br /> --------------------------------------------------------- <br /> REVIEWEDBY------------------------------------------ ------------------------------------------•- ------•------.-....-------­......... DATE---------------------------------------------------------- <br /> BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:--:,:`-- ------ --- ------ ------------------- -------------------------------------------------------------------------------- -------_--------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------- ------ <br /> --------- - -- --- -------------- ------------------------ ------ ----------- ------ ------------------------------------------------------------------ <br /> ... ................. <br /> ------ ----- - - ------------ ---- ----------------- --------- ------ ------------------------------------------------------------------ <br /> A � -------------- <br /> -- ------------------ ------------- --- -- ---- -------------- ­­--------------- ----------------------------------------------------------------------------------- ------------- <br /> FINAL INSPECTION BY-,',� - - ------ --- - -------- -------------- Date-- ----------------------------------------- <br /> SAN JOAQUIN 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,California <br /> 03.9 RrVIBCD 13-59 F.P.CD.2M 6.6D <br />