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' FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No. ._.�_ �...._ <br /> -------------- ---------------------- <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. 9--csv-- q3 � <br /> rt^`� 6�,`'' -f-. <br /> ----------------------------C <br /> ; <br /> JOB ADDRESS �D LOCAT ION__�!�.�-.�____�_.r r�-----. 4 _ <br /> ( / , <br /> Owners Name:-------Gam' Y.. _yQ/d-r'"" T - = <br /> f <br /> Phone- <br /> =�-Address 0i_ �X ----7--5 -----------� 1 = r <br /> Contractor's Name----- -- e-----r----------,Sj__.._.__1------ ----------_------------- --------- ---------- ----------------- Phone---------------- - ----- <br /> ••------- <br /> Installation will serve: Residence C] Apartment.House,0 Commercial El Trailer Court E] Motel [3 Other i z6or flan <br /> House, <br /> Number of living units: _/_--- Number of bedrooms_______: Number of b fhs -------- Lot size __. -d_!'---------------------------------------- <br /> Water Supply: Public system ❑ Community system ❑ Private B- Depth to Water TablcV70 1f. <br /> t <br /> Character of soil to a depth of 3 feet: (San-l"❑---Gravel [I Sandy Loam ❑ Clay Loam ePCfay ❑ Adobe ElHardpan ❑ <br /> I. <br /> I Previous Application Made: Ilf yes,date--------_..---.....) No P- New Construction: Yes ®- No ❑ FHA/VA: Yes ❑ No [E <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet. <br /> r <br /> Septic Tank: Distance from nearest well__' ______Distance from foundation___°__________Material_/�i' � Fr4��`^- -rEfi <br /> --( <br /> No. of compartments_____`�-----------------Size__�'y��l �X--_�- '-�-Liquid depth------- -----------Capacity.--- ✓- ----° . <br /> ` Disposal Field: Distance from nearest well ._�__'__.._D.istance from foundation__.-L_°-----------Distance to nearest lot line__3�_�_____. <br /> [ Number of lines_____ _._----------------Lengfih of each line------ of trench-------3_�________..------------ <br /> P g qua i <br /> Type of filter material__�oS=._�_______De th of filter material-_11.i�_____.Total length ___________________.__________.-_ <br /> Seepage Pit: Distance to nearest well.____._--------_'____Distance from foundation________ _______Distance to nearest lot line_-__-____.____-. <br /> _ ;�""'Nu'rYibe ofrits - ..-....__r� �• - " — - P._ _----_-__ <br /> ❑ ��� P _Loring material_______.-_-____ _ SizeTDiemeter_______________ De to <br /> Cesspool: Dia of nTo-fmm nearest well'----------------Distance from foundation----------.---------Lining material-------------------------------------- <br /> F1 Size: Diameter:.__--`- _----- -------------Depth---------------------- <br /> Liquid Capacity gals. <br /> �I <br /> q P y------------------------- g <br /> Privy: Distance from nearest well_- ----------- Distance from nearest building------------------___________-.______--. <br /> Distance to nearest lot line_ --- -------------==---- ---------_� ------------- --------------------------------------------------------- <br /> " --------- r . <br /> i <br /> Remodeling and/or repairing desscr;bbe):-------.:: .`----- - -------------------------------- <br /> ---------------------------- - •----•------------------- <br /> •---- ----- - U �'f C/s �� C -rr" f`}�' ` '' F ------------ - -- <br /> '- -T --- ------•7-----y-•- -----=---- = --------- -��-- ----------------- <br /> ------ ------------------------------------1 -- - <br /> f <br /> ------- <br /> - .= F..- 254 i_ 1-------------------------------- <br /> I hereby certify that I have prepared"this application and that the work will be done in accordance with San Joaquin County 00 <br /> ordinances, State laws, and rules and regulations of the Sa.y Joaquin Local Health District. 9r <br /> i <br /> - / (Owner and/or Contractor) <br /> (Signed) 'M� <br /> By------------- -- •--------------------------------------------------------------------------------------(Title)------ ------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> l <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEP ET D B ------- ---- ; -.-- ----- ----- ------- - - ---- D"ATE--------- <br /> REVIEWEDBY---- - ------------------------------------------------------------------------ ------------------------ - ------------ DATE-- --------------------------------- <br /> BUILDING PERMIT ISSUED---------------------------------------- --------------------------------------------�-f s�i�pA�7E <br /> Alterations and/or recommendations:-_____________________ __ f/ <br /> ----------------- ------- ------------------ -----•---------------- ----------------------------------- ---------------------I------------------------------------------------------------------- ----------------- <br /> ---------------------------------------------------------------------------------------------------------- --------------------------•---•----------------------------•-------._.-...--------------------------------- <br /> ------------------------------- <br /> ----------­ --- - ---------------------- - ------------------------- ------- ----- _ <br /> FINAL INSPECTION BY: - `� Date-------- ----3 �`Y `5 <br /> S N JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> y � <br />