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FOR OFFICE USE: <br /> ----- <br /> APPLICATION a,FOR SANITATION PERMIT Permit No. <br /> .......... . -- -- ------------- ---- --- <br /> ---------------------------------= -_ _,----------------- (Complete-in Duplicate) Date Issued (g,7 <br /> ---------------------- ----------- --------- This'Permit Expires I 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 /> 'p. <br /> .? --------- ------ 4x--------------------------------------------------------- ---------------------- <br /> JOB ADDRESS AND LOCATION-- <br /> Owner's Name------ <br /> 7-Dly-; A--------- ------------------------------------ ------- -------- -------------------- ----- - Phone--- <br /> M <br /> y----- <br /> Address---------------S. /I A ----------------------------------------------------------------------------------------------------------------------I-------------------------------------------------- <br /> Contractor's Name------/ -------------------------------- ------- -------------------------------------------- - Phone----------------------------------- <br /> Installation will serve: esidence [] -Apartment House [_1 Commercial [I Trailer Court jk] Motel E] Other ❑ <br /> Number of living units: -- ----- Number of bedrooms V_._ Number of baths.-------- Lot size -- ---- ---------------- <br /> Water Supply: Public system 0 Community system El Private , Depth to Water Table 6.0- ft <br /> Character of soil to a depth of 3 feet- Sand E] Gravel E] Sandy Loam El Clay Loam [j Clay 0 Adobe� Hardpan ❑ <br /> Previous Application Made: {If yes,clate., /,..� <br /> A�/ <br /> .66-7) No El New Construction: Yes E] No n FHA/VA; Yes D No n <br /> TYPE OF INSTALLATION AND SPECIFI ATIONS: <br /> (No septic tank or cesspool permitted if public seweris available within 200 feet.) <br /> 1- t .Cr ------ <br /> Septic Tank: Distance from nearest Distance from foundation-./Q- .---.-.Mater <br /> -----M a e a . <br /> No.-of compartments------2---------------Size-3,Y-1----- -----------Liquid depth.---. --------Capacity----g.,no <br /> Disposal Field: Distance from nearest well..XiP------Distance from founclatiion__./_<�---------Distance to nearest lot line_? <br /> 64 Number of lines-------k�.... ----------- ---L g+ of each line-- -----90---)-,r--------Width of trench---�a__/ --------------- <br /> Type of filter materia epth of filter material...1,P.............Total length....--/r16-0----------------------- <br /> Seepage <br /> ength......116-0----------------------- <br /> Seepage Pit: Distance to nearest well......................Distance from foundation-------------_----- Distance to nearest lot line--.-.--..--.----- � + <br /> ❑ dumber <br /> ine_-------------- <br /> Number of pits.-----------------...Lining material----------------------- Size: Diameter.--------_-------------Depth----------------------------- <br /> Cesspool: Distance from nearest well ----------------Distance from foundation _.- ----- - Lining material---....-.---.-..---..-..------------- <br /> ...........Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> El Size: Diameter. <br /> Privy: Distance from nearest well.------__-:_:.._-------------------------- Distance from nearest building.-..------.--------.----------_-.-----.-. - <br /> Distance <br /> uilding.----------------------------------------- <br /> Distanceto nearest lot line_.------------------------------------------------------------------ -----------V--------------------------------------------------------- <br /> Remodeling and/or repairing (describe):____ ------;__----r- - ----- <br /> --------------------------------------------------------- ---- --- -------- ... .....................I-------- ---------- ---------- ------------- --------- ------------------------------------------------- <br /> ----------­­-------------------------------------------------:--------- -------------------------------------------------------------------------------------------- ------------------------------- --------------------- <br /> ------------------------------------- ------------ -------------:-------------------------------------------------------------------------------------------------------------------------- -------- ------ - ------- - --- <br /> 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 the San Joaquin Local Health District. <br /> ---- (Owner and/or Contractor) <br /> ------------------------------------------- ------------------ - <br /> (Signed)--------------- ----------m------ <br /> BY:-------------------------------- ------------------------ -------------------------------------------------------------------------(Title)---------------- ---------- ------I------1-1------ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED ------------------------------------ DATE----- ------------------ - <br /> REVIEWEDBY-------------------- ------------------------------ --------- .... --------------- - ------ ------------ ----------------- DATE---------__......---------------------------------------- <br /> BUILDING PERMIT ISSUED-------- ---------------------- ...... ---------------------------------------------- ----- ---------- DATE-- -------------------------------------------- ----------- -- <br /> Alterations and/or recommendations:---..------------------ ----_ --- -------------------------- ------------------------------- ------------------- ----------- ---------- ------------------ <br /> -------------------------------------------------------------------------------------------------------------------------------------------------- ---- ------­-­------------------- ------------------------------------ <br /> ---------- - --- ------- ------------------------------- ------- ------------------------------------------------------------------------------------------ ----------------------I---------------- ----------------- ---- <br /> -------------------------------------- ...........................................---------------- --------- - ------ ------------ - --- -------- ------------ ---------------- - -----------­ ---------------------------- <br /> . ........... ------------------...... ........... --- --- - - ------ ­------ .............................I........................................................... -------------­------------------------------- <br /> FINAL INSPECTION Date-_ 7--------------------------------------- <br /> SAN <br /> ...........----------------------------- <br /> SANJOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,Catiforiiia Lodi, California 'Manteca,California Tracy,California <br /> E,H-9 2M 1-67 Vanguard Press <br />