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' FOR OFFICE USE: y/4y /33 0 <br /> h _ "__:.-------- APPLICATION -FOR SANITATION PERMIT Permit No. .1.Dol. .. <br /> -------------- --- -------------------------- (Complete in Duplicate) <br /> 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 applicationeis madin compliance with County Ordinance N 549. ��� 'U'70-/00-// <br /> 3 <br /> r <br /> 1�I <br /> JOB ADDRESS AND LOCf'�TION''i � �__ r�-�1t�=--'�----I&--- <br /> JOB <br /> + Phone <br /> Owner's Name--------- = --73?• . ---- - - -- <br /> p <br /> -------------- <br /> Address.....---------- ------•-4 =V4 �`L- 1 �;� ------ ----­--------- <br /> Contractors Name-------- = L/----•---- -------------------------------------------------------------- Phone. <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: --/.- Number of bedrooms __/_ Number of baths _A2_ Lot size <br /> ------------------------ <br /> 1 Water Supply: Public system ❑ Community system elp"rivate ❑ Depth to Water Tables 9_ ft. <br /> Character of soil to a depth of 3 feet: Sand [:] Gravel E] Sandy Loam El - Clay Loam El Clay El Adobe �ardpan ❑ <br /> Previous Application Made: (If yes,date.._.-- 1 No R" New Construction: Yes Y?"No ❑ FHA/VA: Yes ®—No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ; N <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest jel_. _Distanc¢ from founplati n___ Q_ ____.Mate�ial_Gs . ` _ s-? ~ <br /> ®� No. of compartments.. _.-. _-Size_,.$Xd--___� y[iquid de%th__ _' - l"--------Capacity_ _4'~�p_ � <br /> Disposal Fiekd: Distance from nearest wellA ..-Distance from foundation---ej_.__---.Distance to nearest lot line_4;-___.------ <br /> Number of lines___._,...... . Length of each line- <br /> Width of trench. _r____ _________:____-_--_.- <br /> delf 001 <br /> Type,of filter material� �._Depth of filter material__.f -_____.._Total length__���:------------------------ <br /> C Seepage W:S1jt'KV Distance to nearest tgwell_�-��.wDistante fr m fo ndation_ s ________. Dista ce to nearest lot line_.._.___-... <br /> Number of pits________________Lining material_/ � ..5ize: Diameter_' � �_Depth__. _._._ <br /> ------------- <br /> Cesspool. Distance from nearest well-------------- ---Distance from foundation--------------------Lining material---------------------------.-___-_--. <br /> ❑ Size: Diameter. ---------------°-----.Depth_------------------- --- -------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well------------------------------------------------- from nearest building--------------------.-_-.-_-----.-__.._.-. <br /> ❑ Distance to nearest lot line------j-------•---- �-------------------------- ------------------------------------------------------------------ -------- -- ------------ - <br /> Remodeling and/o� repairing (dEscribe):-------- ""t' ,----- - --- ---------------------------- <br /> ---------- ---- ------------------------------- ----------------------------------------------- ---------------------------------------------------- <br /> ---- -- ---------------------------------------------------------------------------------------------------------------- <br /> - ------=----------------------------------------------------------------------------------------------------------- --------------- ------------------------------------------------------- <br /> I 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 tate San Joaquin Local Health District. <br /> (Signed) _______________________: or Contractor <br /> By:-------------------------- I/ )Title}.- // <br /> ----------- . ......... ...... <br /> (Plot plan, showing size of lot, location of sys in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY ----- --------------------------------------------------------------------------- DATE--- lb ------ ----- ---- ---- -------------- <br /> REVIEWEDBY---------------------------------------------------------------------------------- ---------------------•-------------------- DATE-----------------------------------•----------------------- <br /> BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE----- ------------------------- <br /> Alterions and/or recd endations:.------------ ----------------------------------------------------------------------------------------------------- ---------------------- ---- <br /> ib� 7, - ------------------------------- ----------------------------------- --------- <br /> CO-®_ ------- <br /> - ------------------------------ <br /> ------------------- <br /> i FINAL INSPECTION BY:.. C -------- - --- ---- -------------- Date /77:-/ = <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> f Stockton,California Lodi, California Manteca,California Tracy,California <br /> t <br />