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FOR OFFICE USE: <br /> ---------- =------ ----------- ----- <br /> t* Wl APPLICATION FOR SANITATION PERMIT Permi#'No. <br /> ----------- ------------------------------------ <br /> --------------------------------------------------------- <br /> (Complete in Duplicate) lr� <br /> Date Issued ---- <br /> ------------------------------- <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 compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION------------- ---------------------- `f---rr�-` .-•----------- ------------------------------------------------------------------------ <br /> Owner's Name------------ -k_ is 49- f ' Phone...../✓`7P✓' - <br /> Address ' ---------------------i---- <br /> Contractor's Name.. ... OL' . ... --------------------------------------- Phone..... `?. <br /> Installation will serve: Residence [g Apartment House Commercial--L] Trailer Court ❑� Motel ❑ Other ❑ <br /> Number of living units: __f___ Number of bedrooms Number of baths '___ -. Lot•size!7_°T_`__X---ll - <br /> Water Supply: Public system 0' Community system ❑ Private-171 Depth to Water Table 5_0. ft.J <br /> Character of soil to a.depth of 3 feet: Sand P Gravel ❑ Sandy Loam ❑ .Clay Loam ❑ Clay ❑ Adobe)K Hardpan ❑ <br /> Previous Application,Made: (if yes,date44 . _Z/­S) No ❑ New Construction: Yes,® No ❑. 'FHA/VA: Yes ❑ No,® <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic''tank or4cesspool permitted if public sewer is available within 200 feet.) <br /> t - - <br /> Septic•Tan 1 Distance..from nearest well_________________Distance from foundation--------------------Material_-_-__.._---____________________________________- <br /> e 3 e. „ <br /> � ( No. of•'compartments--------••---,--�-/----- ----Size------•-------k-----------•--.•.Liquid depth------------ ---------Capacity------------ <br /> -- <br /> isposal Field: "Distance from nearest well__/AdI LOistance from foundation____l27'1 ..Distance to nearest lot line__ _.5..__... <br /> j f <br /> Number of lines--_-_-___.--�--------- ------Length of each line.------------__�ri__._.Width of trench..______.____-•____�„________...__ , <br /> Type of filter material —_.Depth of filter material--------/-9--- .....Total length...............�� d------- <br /> eepage Pit: Distance to neatest well _Distance fr f ndation_____! '.._..Distance to clearest lotrline_/__. <br /> Number of pits:__.____;"____-_L'fining-material____ _-- Size: Diameter_____ _.��-____..Depth_______ _ -------------_- <br /> Cesspool: <br /> ______________ i <br /> Cessp <br /> ool: Distance from neare's't well_________________Distance from foundation._.._.__.'___._---.Lining'material.__..--------------------- -_________ t <br /> ❑ Size: Diameter--------------------------------------Depth------------------- ---}------I-------i----------Liquid Capacity---------------------------•gals' . . ! <br /> Privy: Distance from nearest well ___________-----------------------------------__Distance from nearest•building.-------------.---------------------------- <br /> ❑ "Distance to nearest lot line------------------------ --------- ------ ------------------------ - ------ " `-------------------------•------------'------- <br /> tx <br /> Remodeling and/or r pairin (d cr' e <br /> ------ <br /> ----- i------- ------------------------ <br /> ---- <br /> -—------------------- <br /> • ----- <br /> ------------- <br /> 'r <br /> l <br /> - - i-- ------- _y � <br /> 1 ?.____.••_______-___•_-'__•-_----_________•_________________ ____._-__________________•_______ <br /> i <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 laws, and rules and regulations of the San Joaquin Local Health.District. <br /> n <br /> Si ned ------------------'---:------------- ------------(Owner and/or Contractorl i <br /> ( g } ----------- <br /> --(rifle)--------------------------------------- --- - --------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY- ; <br /> - ------------------------------- DATE r <br /> APPLICATION ACCEPTED BY --•-------------'--.------------------------------------ - <br /> REVIEWEDBY------------------------------------------- ------------------•----------------------------------------------------------- DATE•-•------••------------------------------------------------ ` <br /> BUILDING PERMIT ISSUED_______________ --------- <br /> ----------- <br /> ----~__. ---=--- ---- •- ----- - -- -----------• <br /> ------ ---------- <br /> --------------------------------------- --------- - --- ----------------------------- ----------------------------------------------------------.----------- • ...._.....------ ------------ <br /> .......... ------------------ <br /> 1 <br /> FINALINSPECTION BY-- - ---------------------------------------------- ------------- Date---------------- ---------------------- -- -------------------------------- <br /> SAN JOAQUIN LOCALHEALTH DISTRICT <br /> 130 South American Street 300 Wed Oak Street 124.Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California * mcinteca,California Tracy,California <br /> E8.9 REVISEP 61.89 F.P.GO.2M 6.60 <br />