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FOR OFFICE USE: <br /> ---------- --------- -------- <br /> 4 <br /> -- -tl - ............. ..// - APPLICATION POR SANITATION PERMIT Permit No. W/- <br /> ---------------- ---------------------------------- (Comple+e•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 /> �s <br /> -42 <br /> JOB ADDRESS AND LOCATION___--- .• <br /> Owner's Name--------- / <br /> Address----•-------------- <br /> i -_1 _� = I` `7. Phone <br /> Contractor's Name.c�-__. _�-�� 1 - �� <br /> --------------------------------•--- <br /> - - -------- ­---------------. Phone_ . _6-=' _VZ <br /> Installation will serve: Residence ,, Apartment House Commercial <br /> ❑ Trailer Court ❑ Motet ❑ Other ❑ <br /> Number of living units: A..___ Number of bedrooms -�- Number of,bafAs _1__, Lot size - r � <br /> ------------- -------- <br /> Water Supply: Public system X Communitysystem y ❑ Private ❑ Depth to Water Table . ft <br /> Character of soil to a depth of 3 feet- Sand p Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe " Hardpan ❑ <br /> Previous Application Made: {1f yes,date_-..-_____--- l No ❑ New Construction: Yes ❑ No [ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ) <br /> (No septic tank or cesspool permitted if public sewer is available witkin 200 feet.) <br /> Septi Tank: Distance from nearest weft- Rf_._Distance from f undation--`. <br /> 1 - M a �r�a i - , <br /> No. of compartments--i4_ Siz Liquid de th _.. Capacity.-- �- <br /> -- <br /> r - <br /> Disposal Field: Distance from nearest well.00A.'� --Distance from foundat' n-. .4 <br /> ......._.Distance to nearest lot line_-__-_: <br /> Number of lines .-.-�---- ---- ------- Length of each line__..-- .- Width of trench...._ �___/___ <br /> Type of filter mafieriel " Depth of filter materia ..___--. -/r <br /> -. Total length------------------------ <br /> Number <br /> -------------- - ----------- <br /> WO <br /> Seep ge Pit: Distance to nearest well_ t <br /> _---_Distanc from foundation__--_/Z_.Dista« to nearest lot line--.4s+ __-._ <br /> Number of pits---I__---_--_---_.-_Lining material-KC.0 ]----- Size: Diameter- 13 -' <br /> 3 Depth..�6r- ------------------ a <br /> esspool: Distance from nearest well ----`rrsr..—�Distance•from{f;oundation..._._.-.--._.. . Lining material---------------- --- <br /> ---___----_----- <br /> ❑ Size: Diameter Dept.i-- ---------------- -------i4---- Liquid Capacity- ------------ -- 9als. . <br /> Privy: Distance from nearest well..___...`___... {,.....-__.... -. _.�Distance from`nearest building__..---_----_-.---.__ 4 <br /> ❑ Distance to nearest lot line... t.,._ <br /> ---- <br /> Remodelingand/or repairing describe :-- ..._..___ ' e� t <br /> --------- <br /> ----------------------------------------------------- -} ----`-------------- <br /> ~ -----------= - ------------------- <br /> . x <br /> ----- ------------ ---------------------•---------------------- ---I----------------- ------------------------------\, - -,— =T — <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, pr4rules and r gulafiorts of the San Joaquin Local Health District. <br /> (Signed) <br /> • .. <br /> / tContractor) <br /> ` <br /> , - �or <br /> Y ----------- --- --- ----- -- I il <br /> - ---------(rifle) - <br /> (Plot plan, showing size of lot, location of system in•rely n to wells, buildings, etc., can be placed on reverse side). <br /> F FOR DEPARTMENT USE ONLY 1 <br /> APPLICATION ACCT PTSD BY............. <br /> t <br /> --------------•--- -------------------------------- ---------- DATE----_s�!= - <br /> REVIEWEDBY------ - --------------- - ----------- - - --- DATE--•- �- ---------------•--- - •- - ` <br /> - - - - --BUILDING -------------------- <br /> PERMIT ISSUED-------- -- ------ ---- ....-- --------------------------_---------- ------- DATE---------- <br /> - <br /> ------------------------------ <br /> Alterations and/or recommendations:....--.�•-4. �_/C__----a�-��!3 3��--�. _ <br /> --- ` <br /> - --------- - ------------------ ----------------1-- <br /> FINAL INSPECTION BY------------ <br /> -- `------- -------------------• - ------------- Date-. 'Y /"4 f <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street <br /> 205 West 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> E.N.9 2M 1-67 Vanguard Press <br />