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FOR OFFI USE• <br />--__ - :• ._ .__ -__"- --,>�-�/CG ar-_ -'3 __ APPLICATION FOR SANITATION PERMIT Permit No. ...�.. _ _ <br />---------- _------------------------------ -------------- (Complete in Duplicate) Date Issued ....._____�// [41 <br /> -_] y +This Permit Expires 1`Year From Date Issued <br /> Application is hereby made to the Sart 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. S49. , <br /> JOB ADDRESS AND LOCAT ---07Qw1-----�,�,�-- -'1� -- ------ -_ "---------=------------------ <br /> ------------------------'--.._--------•-- --- T <br /> Owner's Name_ w Phone______________ <br /> �fd#(fps ----------------------------------------- <br /> Address------ - •----- ------------------------------•--------- - Phone....----•---•---------..._-------------------- <br /> Address <br /> -------- <br /> -------•--• <br /> Contractor's Name-----fY" ... � - <br /> installation will serve: Residence W�—Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> ` ss�� <br /> Number of living units: !-.___ Number of bedrooms�:!-_. Number of baths _/_.Lot size _���� ........___------- <br /> ------------- <br /> i <br /> Water Supply: Public lsystem�;❑ *Community system Private ❑ Depth to Water Tablef�;oft. <br /> Character of soil to-a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam.❑ Clay Loam [❑ Clay ❑ Adobe iardpan ❑ <br /> PP y !� Construction: Yes R3--No ❑ FHA/VA: Yes gi�'No ❑ <br /> Previous Application Mader lv es,date__--=______________) No New,Construction: <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:t : <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) { <br /> Y .�.. <br /> Septic Tank: Distance from .neareist well-----------___Distance from foundation__AV--------:M tefiaj___ --`__ _ _ ____________ <br /> No. of compartments______ _ .__ <br /> �i .-._- Sizeq __x �:�.Ligwd depth--- --------------Capacity-- - --------- <br /> Disposal Field: Distance from nearest well--- ..._FDistance from foundation:__. _=__Distance to nearest lot line__4 - __. <br /> ®�� Number:of lines________.___ __.:_ _Length of each liners-._ R" Width of trench _ __ ___________"____.-_ <br /> of filter material_ �1Pt p �� g --------------------- <br /> Type ` <br /> .. -- ---- <br /> De th of filf'er-material=_ .___-____Total len th....Xb0!.V�_____ <br /> Seepage Pit: Distance to nearest well 4__-�j`-.-----Distance <br /> am fun dation_ -__.... i ante to nearest lot line. ______ <br /> Numberrof,pits__ _`.___-_-.___Lining material ,r����_______-Size: Diameter `f------------Depth s ---_ <br /> Cesspool: Distance from nearest well_________________Distance frorri foundation __-__"_____:__._.Lining material______._____________._.....-._..___.-. <br /> ❑ Size: Diameter------- -f-----------------------------Depth---- ,; _ Liquid Capacity <br /> Size: <br /> Privy: Distance from nearest welt_______________ ________-____.---__._-___-.-__Distance from nearest building--------_-._-------_._________________.- <br /> ❑ _ ----------------------- <br /> 'Disfance to nearest lot line----------- --�------------ --��------------- -•-•--•----------------------------- <br /> Remodeling and/or repairing (describe;:---------l4C <br /> ----­--­---------------------•----------------------...------------------------------------------ <br /> F x <br /> ; .: <br /> - - ------------------------•--•------------ ----------------------•-------------- <br /> ... <br /> I hereby certify'fhat I have prepared this'application'and that the work will-be done-in accordance with San Joaquin County <br /> ordinances, State laws, an,0 rules and egulations of the San Joaquin-local Health Disiricf. <br /> (Signed) . - ------- ------ --- - -- ---- t ,e Contractor} <br /> ;` Title <br /> (Plot plan, showing size#of lot,.location of syst in relation fo.we Is,'buildings, a+c., can beiplaced on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----6- ---------:- . ------------------------- <br /> ------ DATE------- --z/ ----------------------- <br /> -REVIREVIEWED <br /> EWED BY----------------------•- -----------------=-----_-- ------------ '------------:-------------= ---------- ----------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED------------------- I---------=°-----------•------------=---------------!--�----- -------- DATE. - ------------------------------------------------------ r <br /> Alterations and/or recommendations: ..............= -- ---------------• -- ------_------=----------------•-----------...---.........---------------------•---•--------•- <br /> -•-------•-----------------------------------------=--••-•-•-•-----=-------------- --------- ---------------------------- <br /> i�. �, <br /> = c- <= '._..__.. ................... ------ <br /> ------------------- <br /> -------------- --------------- ------ ---- "--- Apl�n c--„ c r 3----.-------.---"- <br /> rt <br /> - <br /> ------------------------------------------------------------------------------------------------ - <br /> FINAL INSPECTION BY:C�_.,.1`_ '(-/ rC<t !' '!__ 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,Colifen,la 14 '�. Lodi,California Manteca,California Tracy,California <br /> EB-7 REVISED B-59 F.P.r C.2M 6.613 d <br />