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FOR OFFICE USE: <br /> --- <br /> ----------------- _ APPLICATION FOR SANITATION PERMIT Permit No. ........ ............. <br /> ' --- <br /> ✓ This Permit Expires 1 Year From Date Issued <br /> ..-..---------- > <br /> . Y �',j_'�S__.____.--- = Com lete•ln Duplicate) <br /> --- ------- - ----- �-- - -- -------- p 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 /> I <br /> JOB ADDRESS AN CATION.--- --------IMA-�---------rQ....v47-----------5L4mexvV <br /> --- <br /> Owner's Name------ ---- -- - - ___- ----- - Phone-44f.--- 7 <br /> 77 ' <br /> Address----------------�4J-3----- --- -- - -- - - -- -- -- ---- - - - ----•---�_�'Z`ll��f�1_.�_�./-�-,-,- -----------------...----- <br /> Contractor's Name--------------------- -- . -------- -_-- <br /> 0 Phone�fu/1 � 1�,, <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court❑ Motel ❑ Other ❑ <br /> Number of living uriits(l)__ Number of bedrooms ` ._ Number of baths I_____ Lot size y1---let ----- <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water TaWeW­- ft <br /> i <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel;❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe K Hardpan ❑ <br /> Previous Application Made: (If yes,dote_. --,.,;._,..F = ) No S. New Construction; Yes ❑ No FHA/VA: Yes ❑ No ❑ Q <br /> I 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_WV1JS<_Distance from foundation--------------__`...Material ._..____---___..._---.._____---. <br /> ❑&S-4AIG No.'of compartments..'............s_`._...Size.---t---- ------ -----------Liquid depth---- ---- -. -- -- ---Capacity-.•--------------- <br /> Disposal Field: Distance from nearest weft-AW5--.-Distance from founclation__:.�,Q..__`_.Distance to nearest lot line___��____r_----- <br /> Number of.lines___ � .__.___ Length of each line-40 ------ Width of trench �!--_____________________- <br /> of filter material__ __- . _._.!: _._..._Depth of filter material----- --- ---------f--Total length----- ------------------------- <br /> Type <br /> #: c.) <br /> Seepage Pit: Dis#ante #o nearest well�f��E._.._Distance�f om f ndation__�'_,�_�'___.Dist�ce to nearest lot line-✓ <br /> Nu�ber ofi pits-.C-L)..._._-_.Lining material--l7� .- Size: Diameter. .-._i4?----Dept h__-�„�'--___--._ <br /> Cesspool: Distance from nearest well _______________Distance from foundation----------------- ..Lining material_-----_....__.___.____________.._. <br /> ❑ Size; Diameter' -Depth--------- ------------------ --- ------Liquid Capacity- ----------- ---- ---------gals. <br /> 2 <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_-.-___-__.____.____________.___.._._. <br /> ❑ Distance to nearest lot line - -- ----------------- <br /> RF i Remodeling and/or repairing (clescribe) ,_ _______________ <br /> i �' 1 <br /> --------------------------------------------------- -•-- - ------ ---------------------------------------------- <br /> -------------------------------------------------------------`---`-_------------------------- i <br /> - 3 <br /> - ------------- ----------- ----------------•-------------------------------------------------------------------------------------•--------------------------I------------------------------------------------- <br /> I hereby certif aUioca <br /> this application and hat +he work.will be done in accordance with San Joaquin County <br /> ordinances, State aws, alotions of the San aquin Local Health District. <br /> (Signed)--------------- ----- -- ---- ._....--- ------- ----- --- --(Owner and/or Contractor) <br /> iBy:--- ------- - - ---- ----- ------ --- - --- -- -------•- -- ----------------(Title) -+--------------------._....------ <br /> I (Plot plan, s mg size oto+ tion of system in rela+io +o wells, buildings, etc., can 6e plat on reverse side). <br /> I FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --------------------------- ------ -- -------------- DATE......�� ------- <br /> -- - ---------------- <br /> REVIEWEDBY----­------------------ -------------- --------------------------------------- DATE--.-- .------------- --•------------------------------• <br /> BUILDING PERMIT ISSUED-------- -- - -- -------------------- --------------- ---- ------------ ------ - DATE---------------------- ---------------------- <br /> --------- <br /> ---------------- --. <br /> Alterations and/or�rj'o "endations:-------------- R ------ --- <br /> 00 <br /> = ------- - <br /> r <br /> h ` <br /> FINAL INSPECTION BY: ....... --- -------- ------- Date..--- - ------------------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Naiellon Are. 300 West Oak Stroat 124 Sycamore Street 205 West 9th Street <br /> Stock Ion'California Lodi. California Manteca, California Tracy, California <br />�, E.H.9 2M 1-67 Vanguard Press <br />