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.FOROFFICE USE: <br /> a t. <br /> --- --- ------- � <br /> /I-;_yf�---- APPLICATION FOR SANITATION PERMIT Permit No. .. .. 3..7 <br /> --- ----------------------- --------------------------- (Complete in Duplicate) ' // <br /> This Permit Expires 1 Year From Date Issued Date Issued ______� .-f�-______ <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 /> � + r <br /> i� JOB ADDRESS AND LOCATION------.... -2./.'. -------- . ^._.A?-, C---------------------- <br /> c Owner's Name-------- �-'"�--£-`-'�-------------- ------------------------------ ------------ ---------------- ---- I Phone----�f---4-r=--R-YYj? <br /> Address------..... R_L..S-...-----�.Q' `��-�---------------------------•------------------------------------• ----------------------------------------.....---------------------••--------- <br /> • t <br /> r <br /> � —�-��-��'--:--�-----5--�� -- - -- - - - - - Phone ----+Y-----�_....--- <br /> Contractors Name---- - �- f--------- -- - ---- --------•--------------- --------------------------- <br /> t• �• <br /> Installation will serve: Residence Q',Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: .f____ Number of bedrooms _. __._ Number of baths _l---- Lot size .------ ..-�'___.X-_-_$._V_9---------------- <br /> ._-..__ <br /> i Water Supply: Public'system Er system ❑ Private ❑ Depth to Water Table ........ ft. <br /> Character of soil to a depth.of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe a Hardpan ❑ <br /> Previous Application Made:--(if yes,date----- --------------) No ffr New Construction: Yes ❑ No E�q— FHA/VA: Yes ❑ No EJ— <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic T nk: Distance from nearest well-----------------Distance from foundation-------------..--.- Material-------------------------..---------..--..--_--_. <br /> No. of compartments-------------------- -----Size-------------------- -----------Liquid depth-- ----------- --------- Capacity----------------------- <br /> Disposal Field: Distance from nearest well---1Yc?.......Distance from foundation---!_�_.._-__-.-.Distance to nearest lot line_jS ----------- <br /> ®^ Number of lines- ":= -1----------------------Length of each line--------7- ---`-----------Width of trench-----:z.------------------------ <br /> T <br /> `_.___.____._____------ <br /> Type of filter`material__--ka-4_./.�----_Depth of filter material----.L_8 '- ._..._Total length------- /-------------------_---.- Uy <br /> Seepage Pit: Distance to nearest well--- from foundation--- to nearest lot line..,1r_'_._-..- <br /> i �+ <br /> Number,of pits------1-------------Lining material----_lig-off<....Size: Diameter--- .------ --. --Depth------•C, _._______-__.-__.. <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining 'Material---.--_._..--.----_----..__--_-__-- <br /> Size: Diameter- --------------------------------Depth------------------------------ ---------------------Liquid Capacity- - ------------------------gals. O <br /> --.--.-Distance from nearest buildin - --- <br /> Privy: from nearest well g <br /> ❑ Distance to n©are�110 - ' --------------------- --------------------------------- ------------ ----------------------------------------------- <br /> Remodelingand/or repairing (describe):--------------- --------------------- -----------------------•----------------------- ------------------------------•-•----------------- <br /> = ---------- <br /> t ` - <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 /> (Signed)---------- ,. -------------- ---------------------------------------------------------------------(Owner and/or Contractor) <br /> By:--------------- ---------- ---------------------------------- - --------------------------------------(Titiel ------------------._----------- ...... <br /> S (Plot plan, showing size of loft, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> -. <br /> APPLICATION ACCEPTED BY------` r- - -------------------------------------------------------------- DATE-----7---------4W�----- -------------------------- <br /> REVIEWEDBY................. --`-- r---- -------------- ----------------------------------------------------------------- DATE----------------------------------------------------------- <br /> 4 BUILDING PERMIT ISSUED-----------r- -------------------- --------------------------- ------------------------------------ DATE-------------------------------------------------••------ -- <br /> I Alterations and or reco a datif <br /> ------ --- ------- -- --------------- <br /> -------------------------------- - ------------ ------------------------------- ---•-------------------------------------------------------•--------------------- --------------------------------------- <br /> t 1 I <br /> --------•-------------- ------ -- -------------------------------------------------- <br /> FINAL INSPECTION—BY. - -- -------------------------------------- <br /> �. DSte-.. TJ"��` -------------------------------------- <br /> y SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> 4 t <br /> Stockton,Cc....... t.� - Lodi,California Manteca,California Tracy,California <br /> 'T <br />