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OFFICE USE: <br /> ----- ---- Permit No. ...1. � <br /> ------------------------------------- - <br /> ---- ---------- -------- -------------------------------- <br /> APPLICATION FOR SANITATION PER <br /> ------------------------------- <br /> (Complete in Duplicate) Date Issued Z_1_f""_V <br /> This Permit Expires 1 Year From Date Issued II <br /> Application is hereby made to the San Joaquin Local Health District for a permit to cons+ruct and installi the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. ce <br /> f �- <br /> JOB ADDRESS AN LO TIO t <br /> • �� - Phone ------------------------- <br /> ------------------------------- <br /> ""•---- ---- --y ---- ------ =Owner's Name* -----------------------------------------------------••--------------------•----------- <br /> 1---Address -- -- - -- <br /> Contractor's Name-------- <br /> Phone.---------_---•-"---------------- <br /> Motel ❑ Other ElInstallation will serve: Residence`�partment House F-1 Commercial E] Trailer Court ❑ <br /> Number of living units: ""/---" Number of bedrooms -o"_ Number of baths - .---- Lot size <br /> Water Supply: Public system ❑ Community system ❑ Private 0-1Depth to Water Table ,Z/91t. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam ElCiay Loam El Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: (if yes,date....................) No New Construction: Yes Er"'No [IFHA/VA: Yes �rNo El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) l M <br /> __"Distancerom fountion-__.� ___--"_.M ter' __ _ <br /> Septic Tank: Distance from nearest we p <br /> No. of compartmentsi - SizeC--- ., P-------Liquid depth Capac�tY J <br /> r " <br /> ry*7 -,/V-..----_--.Distance to nearest lot line"__x .x.----. <br /> Disposal field: Distance from nearest well.-_f.l�-"....Distancerfrom foundati <br /> l Num4�er of lines"" _______ _ _ Length-of each line---_ `____ 1----.Width of trench _�____:. I------ <br /> t <br /> I <br /> Type of filter material. DeptlaTof fiber material---.,� (_.Total length,_ <br /> ` <br /> op <br /> f / m fo ndation---W�"".---.Distan to nearest lot line__------__ <br /> Seepage�Pit: Distance to nearest well..l�X-- Distance <br /> Number of pits."---- ------------LinEng material ---.Size: Diameter ......lDepth e '- '-- <br /> Cesspool: Distance from nearest well-_-------------Disf'ance' from foundation--------------------Lining material--------------.------------------..--. <br /> Liquid Capacity----------------------------gals. <br /> ❑ Size: Diamet�-'---------- ---------------- ---Depth--------------------- ---------------------------- <br /> " -_Distance from nearest buildingl <br /> Privy: Dista2e from nearest well---------- -`F-------- <br /> ❑ ------------------ <br /> - ----------------- -------- --------- <br /> Distarice to nearest lot line"".._'____- <br /> -------------- <br /> Reniodeling and/or'repairing [describe)=-------------'d�� � - <br /> ! } -------------------------------------------- ------------------------------------------- <br /> ------------------ <br /> --------------- <br /> -- <br /> ---------------------------------------------------4-------------------------------------------------------------------------------------------------------------------------------------- --- <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 /> w _ <br /> `� �J� V °r Contractor) <br /> (Signed)---------- --- -- --- _ -y <br /> _ ITi+I 14.x- ---- ---------- <br /> $Y� ---------------------- e): <br /> (Plot plan, showing size of lot, location of system i ation to wells, buildings, etc., can be placed on reverse side). <br /> } f . FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED,BY----------- -- - -�-� DATE----- ------------------ ------- ---- ----------------•--- <br /> REVIEWED BY----------------------------------- DATE <br /> -- ---------------------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED.------ ----------------------------- ------------------------------------- DATE---------------------------- - ------------------------------ <br /> Alterations and/or recommendations----------------------------------- -- •--------------•------------"--- ----- ------- <br /> ------------------------------------------------------------------- <br /> ---------------•-------- ---------------------------­_-=-------•-------------- <br /> ---------------------------------------------------- <br /> -----•---------------------------------------------- <br /> N• ------------------------ <br /> -------- --------------- - ------------- - - ----------------- <br /> " � ...----------- ----- - ------------------------ <br /> FINAL INSPECTION BY:-.. ,�_._'_.-_^+ = ------ -------- Date---- ---- ------ - --- - <br /> i <br /> Ij SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 4 1601 E.Ha:ellon Ave. 300 West Oak Street `. 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California �� V Manteca,California Tracy,Caiifornia <br />