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FOR OFFICE USE: — <br /> ---------------------- ---- --------- ---------- ------- <br /> APPLICATION FOR=•SANITATION PERMIT Permit No. :. � <br /> ----- -- --------- -------------------- --------- (Complefe-in Duplicate) <br /> ---------------- -__- __.__._.- This Permit Expires 1 Year From Date Issued 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 /> rpC3� �w .. HrCo-t_r_ 4- ~� <br /> C 00_0 <br /> s' <br /> JOB ADDRESS AND LOCAT N_fXi_ ,7.19s_- --OlV_-.-----5 .Q12�.-.-- J�_h----------------------------.-__-----___-- <br /> -------------- <br /> Owner's Name Q,� !------ ° T ,S`f�. �-- Phone--4f_ 774Z,?-f-! <br /> Address 1pQ- a_------ <br /> Contractor's Name_.. ------- Phone <br /> Installation will serve: I Residence ❑ Apartme`nt�Hou se ❑l Commercial ❑ Trailer Court E] Motel [I Other �C] <br /> Number of living units: -_ Number of bedrooms _______ Number of baths--------- Lot size _____ ___ ________ -------- ------- ._____.___________-_-._ <br /> Water Supply: Public..system E] Community system E] #Private� Depth to Water-Table 4- _ ft > � <br /> Character of soil to a depth of 3 feet- 'Sand [] 'Gravel ❑ Sandy Loam Clay Loam [-] .-Clay❑""Adobe 0' Hardpan'❑ <br /> ` m <br /> Previous Application Made: (If yes,date_.� .-_ ) No E- New Construction: Yes ❑ No 0 FHA/VA: Yes ❑ No ❑ <br /> 1 i <br /> TYPE OF INSTALLATION AND SPECIFICATIONS-4 <br /> (No septic tankkor cesspool permitted if public sewer is available within 200 feet.) <br /> 'I <br /> Septic Distance from nearest well....... <br /> -Distance from foundation___________________ Material --_..__._..__--_.______ <br /> X106 No. of com artments-------------------- ISize,._----------------- ----- Liquid depth---- ---- - ........Capacity ---... � <br /> ! t i cF. <br /> Disposal Field: Distance from near st we-111we-1110-157.-El.-- Distance from #oundaItion----.�_______....._Distance to nearest lot lin _--".__. - <br /> Number of lines _ .. i_Length of each line_ ._�/p____ ff Width of trench._ !1 <br /> f. <br /> Type of filter material--_____:__Depth of fifter material____.f-- _.____-- Total l length.....___________--�-- ------ <br /> --- <br /> Seepage Pit: Distanc—e to nearest well.......... :.._.___:Distance from foundation------------------- Distance to nearest lot line----- <br /> ------ <br /> \0 Number ofpits_--ll�-----------------Li'ning material__--__ ` <br /> __.... Size: Diameter_ Daps- `� <br /> . -------- <br /> - - -----------------• •� II <br /> Cesspool: Distance from nearest --elf: _.. _- Distance from foundation----------------- _Lining maferial------------------ <br /> ------------------- <br /> ❑ Size: Diameter. Depth - - :------------ --------- - ------Liquid Capacity- ---•---gals. <br /> Privy: is Distance from nearest well._.-_�__--_------ --t_ ----- Di'stance'fr'om earest`buildin <br /> Distance tolnearest lot lme---------------------- ---- <br /> ------ <br /> __ __ ----- <br /> ------------------- <br /> Remodeling and/or repairing (describe):- - ----- -- ----------- <br /> --•------------- <br /> ---------- <br /> --------------------------------------------- -------------=--------------- --- -- - <br /> -------------- --•---- - <br /> ------------------------------- ------------ <br /> ! hereby certify thatI ha rep tred this application and that the work will be done in accordance with San Joaquin County I <br /> ordinances, State laws, and r e and,regul ons 4fheSaquin Local Health District. <br /> (Signed)--------------- ----------- -- ------- - 1 <br /> ..._.-.____Owner and/or Contractor) <br /> ay:. - (Title)- <br /> j <br /> (Plot plan, showing size o42_­_��___ <br /> , oation of system in relation to wells, buildings, etc., can be placecb6n reverse side). I <br /> t <br /> FOR DEPARTMENT USE ONLY <br /> �/ <br /> APPLICATION ACCEPTED BY--- -�� 4 ------ r-��-�-d----------------------- - DATE---- 5?_—-„"&-s- �---------- - - � <br /> REVIEWED BY----------------------- -------;----- ----- ._ DATE- <br /> BUILDING <br /> ATE BUILDING PERMIT ISSUED-------- -- ---- I---------------- -•--------------- - DATE <br /> Alterations and/or recommendations:------- --------------------- - --- ----------- -------------- <br /> -- - <br /> -------------------------------------------------------------- -------------------------------------------------------------------------- ----- -------------------- <br /> . I <br /> -•------ -- -----------------------•--------- 1 <br /> -- ---------- --------------------- ------ ----- ------- ---------- ------------------------------ ----------- ------ <br /> - - _.._._-------------- - -------- --- ------------- <br /> - r <br /> . --- ------.. ------------------- - ------------ - --- - -- ---------- --------------------. ------------ <br /> t � a : <br /> FINAL INSPECTION BY...- ---.-__-- _ --- -/--�--�..- -Q <br /> "'.` -•------------------ Date-------.........-- ---------------- <br /> --------------- - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxelton Ave. '300 West Oak Street 124 Sycamore y amore Street 20,5 Wast 9th Street <br /> 9 <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> E.H.9 2M I-67 Vanguard Press <br />