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FOR OFFICE U5E <br /> i <br /> ------------------------------------- -- --- ---- <br /> APPLICATION FOk SANITATION PERMIT Permit No. ..�..7...T.,AZ-. <br /> -----------------------------I---------- --------------- (Complete in Duplicate) <br /> This Permit Expires 1 Year From Date Issued Date Issued <br /> PP <br /> A lication is'hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This applicatioh is made in compliance with County Ordinance No. 549. 15 a� <br /> JOB ADDRESS AND LOCATION....... --------: --- ``°`' <br /> Owners Name------ :Im�Y?------- � ----- - <br /> Phone <br /> 04 <br /> Address .. '--•--- --F -----Irv- �-�� �l <br /> Contractor's Name---- -.----•----------------------------------------------------------------------------•-----_ Phone----------------------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number• of living units: {------ Number of bedrooms . --. Number of baths --�___._ Lot size _7�1._ __ IE ------------------------------------ <br /> Water Supply .Public system ❑ Community system ❑ Private [5Y] Depth fio Water Table $b__ ft. <br /> Character of sod to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E] Clay ] Adobe ❑ Hardpan <br /> Previous Application Mader (if yes,dote.__:____.._........_) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> .p t <br /> TYPE OF INSTALLATION AND SPECIFICATIONS. <br /> jNo septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: '!` Distance4rom nearest well S'9'___._._Distance fr m foundation IZQ ------- �.+r�1/t1L1 _r _._.. ----------- <br /> d <br /> ' <br /> Liquid depth--- �--------- P yle -- -- 1--h <br /> ® No. of compartments_____ _ __ _ Sizelr _.__�` ___ Ca acit ! ___ <br /> `I Distance from nearest well.S)k----------Distance from foundation__,'------.---.Distance to nearest lot lined~-___________ <br /> Disposal Field Number of lines-------I--- Length of each line_._____QD`'!�___..____._.Width of trench_.-_ '_ _y_._ <br /> -------------------- <br /> 96 Type of filter material��-_-.___Dept of fil#I materie!_I_/_Q__________. _ otal length___ __________________ -._-_-_---___- <br /> Seepage Pit: i Distance to nearest well-_/6_----_-------Distance from foundation___��'_________ Distance to nearest lot line----_---._ <br /> y] '� Number of pits___Y._-___--{_______Liming material Aete-�'. 4 p ! <br /> -------.Size:-Diameter----�'�-�--------------De th__r�=`�--------------- ------ <br /> # : t 1 <br /> Cesspool: j Distance from nearest well____{_-__..__-__Dis�ance from foundation...___- -_-_____Lining material______________________________________ <br /> El Size: Diameter-------------------------I- ._--____---_De th------- rf----------------- ---------Liquid Capacity gals. 1 <br /> IL <br /> �Privy: Distance from nearest well---- ___�_____I-.______._______________Distance from nearest building____________________________________--.._. <br /> ❑ 6 Distance to nearest lot line__._"b"•-------"-----" -- ---------------- ------------------------------------------------------------------------------------------- <br /> - <br /> Remodelingand/or repairing (describe)------ --------------- ----------------------------------------------------------------------•--•----------------------•--------------------------------- <br /> ---------------------------­------- <br /> ' --------------------------------------------------------•--------------------------------- ----- <br /> ------------------------I------------------------------------------------------------------------------------------------------" <br /> ---------------------------------------------------------------------------------------------- <br /> I hereby i',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 /> (Signed) _-_. Owner and/or Contractor <br /> BY= -*��-'�..rl�- - ----------------------------------------------------------------(Title)------------------------------------------------------ --------- <br /> (Plot plan "showing`size of l6t;'1oGation.. system in relation'to wells,"buildings,'etc., can be placed on reverse <br /> .0 <br /> ! FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BYe ..•• ! --- ------ DATE----��- ---- <br /> - ----------------------------- <br /> REVIEWEDBY----------- ----------------------- - - ----------------------------------- --- DATE-------------------- <br /> BUILDING PERMIT ISSUED------------------------------------------------------------------------------------ -------------- -- DATE----------------------------------------- <br /> ------------------- <br /> Alterationsand/or recommendations:.--"--...................... ---- -- - -------------------------------•-----------------------------•-------•---------------------------------------- <br /> li <br /> h <br /> iE <br /> :I1 - ,�� �s <br /> FINAL INSPECTION BY: 11 v�l �! ... - - Date---O- - - - ------- ------------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 6E.Ha=elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California _,qs. Manteca,California Tracy,California <br /> ES 4 REVl5E0i8-59 3M 3-'63 F.P.CC. <br /> it ' <br />