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FOR OFFICE USE: <br /> --------------I---------- ------I------------------ 3 ..... <br /> ----------- APPLICATION FOR SANITATION PERMIT—tz, Permit No. _1 .. . <br /> -------------------------------------------------------- (Complete in Duplicate)- <br /> ------------------ ----- ------ --- -- ----------------- This Permit Expires I Year From Date Issued Date Issued ----�A? <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describe <br /> This application is made in compliance with County O dinance Ng. 449. <br /> JOB ADDRESS AND L CATION-----------225-Zr -5 <br /> --------------------------- -­-------------F---------------------------------- ------ <br /> ------------------- .......__-------------- <br /> Owner's Name---------- --------------4� ------ e-, '2- <br /> ........... --------------- - ----_... .................................................... <br /> ------ --------------------- Phone.4- <br /> Address--------------- -------- ........ ........ <br /> ------------------------------------7---!rig---------- ..... <br /> Contractor's Name------:-----------------------------------------------------------------------------------------------------------------------I-­----------- Phone----------------------------------- <br /> Installation will serve:. Residence JR] Apartment House E] Commercial Ej Trailer Court 0 Motel [3 Other El <br /> Number of living units: Number of bedrooms --_Number of baths _tel__ Lot size ______________ <br /> Water Supply: Public system Er Community system E] Private E] Depth to Water Table -"-:-ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam F] Clay LoamAl Clay El Adobe 0 Hardpan C1 <br /> Previous Application Made: {If yes,date-_________________1 No JZ New Construction- Yes [9 No 0 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---- ______.Material.._ .._.. <br /> ---P_a ;y <br /> No. of compartments-------------- Size..... t.,) Liquid depth____._____----`----------Capacity..... ---- <br /> .. .. ----- <br /> Disposal Field: Distance from nearest well-------_-_.-Distance from foundation------ <br /> 3_�.....Distance to nearest lot line_____--- <br /> Number of lines---------_Z.47--------------Length of each line-------------- _______.Width of trench-------------2— <br /> ------------------- <br /> Type of filter material_��----- _________Depth of filter material--- <br /> "-----Total length_________________j�_ ___r_________ <br /> Seepage <br /> ------------ <br /> Seepage Pit, Distance to nearest well----- -------Distance f" foundation___ Distance to nearest lot <br /> Number of its______. -------------Lining material.. r--r-- ---------Size: Diameter_ __ _ ---- -------.Depth-----------2--1-------------- <br /> Cesspool: Msfance from nearest well-----------------Distance from foundation___._-___...__._--- Lining material---_--________._-_--__-..___.__..._-_ 1 <br /> ❑ Size: <br /> aterial------------------------------------- <br /> Size: Diameter------ ------------------------------Depth----------------------------------------------------Liquid Capacity----------------=-----------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ <br /> F-1 Distance to nearest lot line------------/-----------------------------------------------------I---------------------------------------------------------------------- <br /> Remodeling and/or repairing describe)------------ <br /> . .. ... ...... <br /> -- -- ------ <br /> ------------------------ <br /> ibe):-----------7-t - --------- ------ ------------------------- ----•-- --------------- <br /> - ------------------------------------------ ------------- -- - - ------ --------------- --------------------------------- <br /> - - - ----------------------- <br /> ........ --------------- ----------------- 24-_--_ <br /> ------------------------------------7----------------------- 7: ---------------------------------------------------------- <br /> ---------------------- <br /> 114----------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------- <br /> 4 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances a e laws, and rules and regulations of the San-Joaquin Local Health District. <br /> (Signed, ---------- <br /> ------------------ --- --------------------------------------(Owner and/or Contractor) <br /> Br --------------------------------------------------------- <br /> ------------------------------------------------w----------------------------------------(Title)---------------- -- ----- --------------------- ---------- <br /> (Plot plan, showing size of lot, location of.system in relation to wells, buildings, etc., can be placed on reverse side). <br /> f)6R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------- ---- ------- . ........­ -------------------------------------------------------- DATE------------ ----------- <br /> REVIEWED BY-------------------------------------------- -- <br /> -----------------------------------------------------------------------1•......... DATE--------------------- •---- --------------------------------- <br /> BUILDINGPERMIT ISSUED--------------------7.------------------------------------------------------------------------------- DATE------------------------------------------------------------- <br /> Alteraf ion --------- -------------------- ------------ -------------------------------------------------------------------------------- ----------------------------- <br /> andjor recommendat' * a. I__ <br /> ---------- -- <br /> ------------------------- <br /> - ------------- <br /> . ... ..../-- ----------- <br /> .......... ........ ------------------ ---- ---- R <br /> ---------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------- -------- - - --------------------------------- ---------- <br /> ------11----1-0-__6-1----- ___.width se roved JD1 <br /> _septic. ... . ....�!� -------------------__------------------- --­-------­ •----------------•------------------------------------------------------ - -- ------- --approved ­ � <br /> t_.... -------------------- I'll <br /> FINAL INSPECTION BY:.----- --------- - ---- Date----- ---------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />