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.� FOR OFFICE USE: � ` <br /> o _ Permit No. .Q �d b- <br /> �` f " ------i ---- ------ " APPLICATION FOW SANITATION PERMIT" <br />- ------------------ __-._-_ (Complete in Duplicate) Date Issued ,� --- <br /> " This Permit Expires 1 Year From Date Issued <br /> --- -------- ------ - -------------------- ---------- <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 /Co7u/���in nce N�j 549. <br /> ------------- <br /> JOB ADDRESS AND LO ATION--- _ r----- �- fi-------- -- ------ Phone-------- �------- ------ - Phone------------------------------------ <br /> Owner's <br /> --------------- ---•--•------------ <br /> ----------•----•- <br /> Owners Name-------------- - -���.------ -- - --- ------------•----------•---- <br /> ------------------------ <br /> Address------ =6- -b- -----a­ , � <br /> ------------------- <br /> ------ Phone--•----------- <br /> Contractor' Name__o" " -.�_—� <br /> ----- ------ <br /> - - - ---- - ----- - <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Cour} ❑ , atel ❑ Other � <br /> Lot size �-�1---------------------------- <br /> Number of living units: -------- Number of bedrooms __ -- Number f baths <br /> Water Table __..___- ft. <br /> Water Supply: Public system ❑ Community system ❑ Private � p Adobe Hardpan E]Character of soil to a depth of 3 feet: Sand E] Gravel El Sandy Loam [P/Clay Loam [I Clay E] ❑ <br /> FHA/VA: Yes El No ElPrevious Application Made: {If yes,date............._-__-"I No New Cons#ruction: Yes [�No [I <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public s wer/s available within 200 feet.) <br /> Lam -- <br /> --- <br /> Septic Tank: Distance from nearest well�_k!_� - Distance from foundation-----��] ------.Material__ �Y---- <br /> p Size- ------------ ----------Liquid depth---------------- -------- Capacity <br /> No. of compartments-...__.._- r� <br /> (��..• ��� ��--".__--_Distance to nearest lot lin _ �'_ ._.- J <br /> Disposal Field: Distance from nearest well Blr!.y__/---Ulstance from fours tion-- Width of trench.______ ..____--_.___ <br /> Number of lines-------- _____________________Length of each line`�r'r----- - <br /> e4' Total length---------� ---------------------- <br /> Type of filter material___,'-- -------------Depth of filter material.._.-" � - - " <br /> Seepage Pit: Distance to nearest well---------- ------ Distance <br /> e from foundation�iameter. Distance toDnearest lot line_--_ -------- <br /> El <br /> : <br /> ❑ Number of pits----------------- ----Loring ma rn <br /> Cesspool: Distance from nearest well-___._.-__.__._-Distance from foundation__.________________Lining material_-__.______- als' <br /> -_Depth------------------------------ ------ --------------Liquid Capacity g <br /> ❑ Size: Diameter------------------------ --- --- - <br /> Distance from nearest building--------------------------------------- C <br /> Privy: Distance from nearest well----------------------------------------------- G <br /> ❑ i -------- ----- ------------------ <br /> Distance #o nearest lot ne_________________________ <br /> Remodeling and/or repairing (describe) -- --- --------------------- --------------------------------------------------------• -•-----------------------------------------------------1. <br /> 00 <br /> ---------------------- ------t� <br /> ------------------------- <br /> ------------------------------------- -------------- <br /> I hereby certify that l 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 /> _- -------- ------(Owner and/or Contractor) <br /> (Signed) � '� <br /> Title <br /> -------------------------------- <br /> BY:--•------------------•-----------------•---------- ----------------in- ---ion-- ----------ll <br /> (Plot plan, showing size of lot, location of system--------------- <br /> in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> ----------------------------------------------- <br /> ----------------------- DATE...2!-'r 1771 <br /> --- ----------------------------- <br /> _ DATEDATE ACCEPTED BY---------- -- - <br /> -- -- ------- - ------- ---------- <br /> REVIEWEDBY----------------------------------- "- ---- -- ----- --------- ------ ------ ----------------------------------- <br /> BUILDING PERMIT ISSUED------------- ------------------- ------------------- --------- <br /> -------• DATE--------- ---------------- --------------------------- - <br /> yG ,y <br /> Alterations and/or recommendations:._.__.?'/�°�-���----•� �--- - �""""-"" <br /> l� } ----------------------- <br /> :____ - ---=-------------------------- -� �- --- i ` <br /> ------ <br /> FINAL <br /> - --- <br /> - - ---- ---- -- - <br /> Vz- ------ <br /> -/"/I......... <br /> HNAL INSPECTION BY:------ -' -- -- ------------------------------ <br /> Date.. -- =t '7���j------- -- ----- ------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1b01 E.Haxalton Ave. 300 West Oak Street <br /> 124 Sycamore Street 205 West 91h Street <br /> Lodi,California Manteca,California Tracy,California <br /> Stockton,California <br /> F.P.Rd• <br />