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FOR OFFICE USE: <br /> j114A-------------------- -------- <br />--------------------------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br />------ ------------------------------------------------- (Complete in Duplicate) 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 /> 1 ---------- <br /> JOB ADDRESS AND LOCATION__�6� _-__. - ---�.r--�'-`-�- ��- <br /> Owners Name-- Avlo-'1...../«k---- ---- - - - ---------------------------------- ---------- - --------------- -------------------- Phone---------•--------------------•---- <br /> Address-------- � z -------------------•----------------------------•---------------------•-------------------------------------------------------------------------- <br /> Contractor's Name-- - ------------------------ Phone----------------------------------- <br /> Installation will serve: Residence Apartment House []—Commercial ❑ Trailer Court ❑- Motel ❑ Other ❑ <br /> j a x a 1 <br /> Number of living units: _{__-_ Number of bedrooms .�._ Number of baths __--__.- Lot size _-- __2`______.-._-��,?_________________________________ <br /> Water Supply: Public system ❑ Community system ❑ Private.�Depth to Water Table _.46ft. ( <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [B ardpan ❑ <br /> Previous Application Made: (If yes,date_.- ----------------) No F-_`New Construction: Yes 2r---No ❑ FHA/VA: Yes ❑ No ®_� <br /> 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--+ ----Distance from foundation_1Q--___-___--- Material. --__________________ <br /> �! No. of compartments____z;?-------f- .Size--- `+ -`�_#,___Liquid depth_V- -------------- Capacity_7S__P9 <br /> Disposal Field: Distance from nearest well.0 q_______Distance from foundation--M_.._....._Distance to nearest lot line___-_./----- <br /> td r � <br /> Number of lines_ 9-------._..______________Length of each --- <br /> Type <br /> of trench_. ____..____....---_.-_ <br /> r <br /> Type of filter material-' --------Depth of filter matbrlal---/$-_-- ._.__Total. length--_6�74-_ ----------------_...... <br /> Seepage Pit: Dis#ante to nearest well_/`Vo------------- <br /> Distance from foundation__._/a_._-------.Distance to nearest lot line---5.______. <br /> Number of pits.2---------------Lining materiaLqa-G/C_--..Size: Diameter_-. -------.--_-Depth__ i3`_-________-.- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-------------.......Lining material--_.--_----__--______________--.-_. �. <br /> ❑ Size: Diameter----- -------------------------------Depth----------------- -----------------------------------Liquid Capacity------------------------- -gals. <br /> Privy: Distance from. nearest well-----------------------------------------------__Distance from,nearesf building.___:----------------------------- ...... <br /> ❑ Distance to nearest lot line------------------------- ------------------------------------------------------------------------------•---------------------------- <br /> Remodeling and/or repairing (describe):------------------------- ----- -=--------------------- ---------------------- k--- ---------------•------•-- --------------------- ---- <br /> -----------•-------------------•---- I------------------••-------------------------------------------------------- -------------------- ------------------------------------------------- -- <br /> a <br /> ----------------------------------------------------------•---------------------------------------------------------------------------------•------ ----------------------------------------------- ---------------------- <br /> ------------------------------------------- --------------------•---------------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby cV <br /> have prepared his.application and that the work will be done in accordance with San Joaquin County <br /> ordinances, St {tirules an re lafions the San Joaquin Local Health District.'. <br /> (Signed)----------- ---------- ---- ------------------ ----- ------------------- ---------------- - ----------- --------------------- -------- -.(Owner and/or Contractor) <br /> By. (Title)_ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed onreverse side). <br /> R <br /> FOR DEPARTMENT USE ONLY G <br /> APPLICATIONACCEPTED BY--- ----- ---------------------- --------------------------------- DATE----- - � �------------------------------ <br /> REVIEWEDBY--------------------------------.------------- --------- --- --------------------- ----------- ------------------------------ DATE------------------------------------------------------------- <br /> BUILDING PERMIT ISSUED------------------------ - - DATE - - �= <br /> -------- ---- <br /> Alterations and/or recommendations:_-_-___.. �-----------6-9_ .- d` ��------------------------ <br /> ------------------------------------ ------ ------•------- ------ -------------------------------- ---------------------------------------------------------------------------------------------- f <br /> 3 <br /> FINAL INSPECTION BY......... - -.�� __------- � Date. ---------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> 4 <br /> s '� <br />