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FOR OFFICE USE: <br /> -------------------------- - ------------------- _ g <br /> APPLIC_ATION FOR SANITATION 'PERMIT Permit No. <br /> (Complete-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 /> JOB ADDRESS AND LO ATION._-/y�. ---L�f,11"i---- -- , _ CF1.--/-----A> Cir�o_.-- -- <br /> Owner's Name------. ------------------ - ....------- Phone-------------- <br /> Address-------.t9/�- _•(.d/...�_./f._!p����L 14. .f��--------------------------------- I <br /> Contractor's Name------ _ <br /> r = a� ,G�-------------------------- ------- -- -------------------------------------------- Phone----------------------------------- <br /> Installation <br /> ----- .----------.------------.---Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _/_.. Number of bedrooms _� _ Number of baths-J_?_ Lot size -,- ------------------- <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table l2.0`ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Va' Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: 11f yes,date................... ) No 2-' New Construction: Yes P No ❑ FHA/VA: Yes Z?-'No ❑ l <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> 4 1, � <br /> Septic Tank: Distance from nearest well_450_.. _Distance from foundation--/a----------Material <br /> ' No. of compartments...a�L_------------------Size&k4.`-___1jVJ.fJ_Liquid depth__ ' � __....__Capacity_e d?.' - _.__- i <br /> Disposal Field: Distance from nearest well._14�"10.`...Distance from foundation__jie..._.Distance to nearest lot line-------- -__ <br /> + Number of lines ._.- ? Length of each line__ ` <br /> ❑ , - 9 ��� Width of trench-f2 <br /> Af <br /> Type of filter material j(/6Zx Depth of filter material---f ------ Total length__JAQ-------------------------- <br /> /� __ _..Distanline-4-40_ <br /> ce to nearest lot <br /> Seepage Pit: Distance to nearest well./QQ--____.__Distance from foundation � � <br /> _ . ____ 1 <br /> El Number of pits._._-.__-___-._.Lining material-AVOA'94`"..�_�_.'. Size. Diameter_�'3- __._ <br /> Cesspool: Distance from nearest well ----------------Distance from foundation................. ..Lining material-_ - ._.____..___.__._____-_______- <br /> ❑ Size: Diameter- -- ------_ ---- - - -----Depth---------------�------ --- -__._-.___.__- Liquid Capacity - ----- -------------- <br /> Privy: Distance from nearest well-._-__ .._,------_--__-------- __Distance from nearest building-------.-_ ------------------------------- <br /> ❑ Distance to nearest lot line -------------------------- -------------------------------------------- <br /> Remodeling and/or repairingdescribe)------------- a -1,k- �------xlra� -------------- t <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 /> (Signed) - � -f --- --------------------------------------( Lor Contractor) I <br /> Pfo <br /> --------- ----- <br /> By ------------------------------------------ ------------------------------------ ------(Title) '1 ��i .._....--------------- <br /> (Plot plan, showing size of lot, location of system in rel lls, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BYqU_ - '._. W ------------- ----- ----- ---------------------------------------- DATE-/-I-_� ----- ------------------------------ <br /> REVIEWEDBY-----------------------------------------­ ......... -- --------------- ---- ------- ---------- --------------------------- DATE <br /> BUILDING PERMIT ISSUED-------- -- ------------------------------- --- -------- ---------------------- DATE---------------------------------------------------- <br /> Alterations and/or recommendations:----------------- ---------------------------- ----------------------------------------------L--------._...--------------------------••-------------------- <br /> ------------ -- ------ -- --------- ---- -- ----------------- --------- ------------------------------------------- --••------------------ ---------- -------------------- -- <br /> ` ------------------- ------- ----------------------------------------------- <br /> A , <br /> ---- --------------------------------------------------------- <br /> s;. <br /> FINAL INSPECTION BY:.. -VV. ---- ----- - -- ---------- Date------- -------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi, California Mantecar California Tracy, California <br /> E.H.9 2M 1-67 Vonguord Press <br />