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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT Permit No. Agf.-:� Q..J <br /> V I...� __.-_.- ----. -----_.- (Complete-in Duplicate) ED <br /> ---- ... This Permit Expires 1 Year From Dat ess'ue ��d Date Issued =�Q---.�.� <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 /> Or <br /> JOB ADDRESS AND LOCATION_ --- --- ....... . ....... .- <br /> Owner's Name-------- ----- Al <br /> /- ' // hon <br /> .G/ -------- --------- - - ../I - P e.----------------------- ---- <br /> Address--------------r'� 6-0 - <br /> i - t s' - ---------- <br /> Contractor's <br /> ...._-- - - <br /> Contractor's Name---� - <br /> - - ---­----------- -`-- ------ Phone----. .--` ---------------- <br /> Installation will serve: Residence 1 ] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: --1----- Number of bedrooms -u_.- Number of baths-Fr--- Lot size -._. _.- _:._.`_1-7-Z--_---------_-------- <br /> Water Supply: Public system ❑ Community system ❑ Private•® Depth to Water Table °..:_. ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam h Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date-.__...--.__.- ) 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 within 200 feet.) <br /> Septic Tank: Distance from nearest well--S®---- Distance� from found0ion.._/_0__ __ <br /> J � Matl :a— <br /> "a <br /> No. of compartments....._-�_.--_ - Liquid depth -..._. Capacity - - <br /> Disposal Field: Distance from nearest well.-_0--...--Distance from foundation.../.-0-'... .D'P�ante to nearest lot line-S <br /> _ - _ - <br /> \ <br /> Number of lines ---._9---.- .-._---_...Length of each lineol__ ..d- f�tlh of trench <br /> Te of filter material/� P---- --Depth of filter material-_� ''.---_--.Total length-----,Z-��1. <br /> ---d- <br /> Seepage Pit: Distance to nearest well_ --------_--------Distance from foundation----------_-----Distance to nearest lot line----------------- Q <br /> ❑ Number of pits._-------- --------Lining material------__-----------. Size: Diameter_ ---------- --- ----Dept h_-------- ---------.------_.-- <br /> Cesspool: Distance from nearest well ----------------Distance from foundation__ ---------- ..Lining material------------------------_-..--.----- <br /> ❑ Size: Diameter- -- ----------- --------- ----.Depth_------------- ----------------------------Liquid Capacity--------------------------gals. � p <br /> Privy: Distance from nearest well_............._____---...._. ....--._--_Distance from nearest building----- --------------------------------.-.. �•' <br /> ❑ Distance to nearest lot line - -- ---- --------------- - - - ---.------------- <br /> Remodeling <br /> - -----_Remodeling and/or repairing (describe): .. •------_----------------------- <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 n <br /> ordinances, Sta�t /Iy i�ffs and <br /> JJQrrQles ann egulat' sof h an Joaquin Local Health District. <br /> (Signed)----------'/ ��!bC/r'ri-------Ff�--r----- - ---- e <br /> - _ -- __ ---------.----------- - - (Owner and/or Contractor) <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 /> FOR DEPARTMENT USE ONLY g <br /> APPLICATION ACCEPTED BY... l _ -'----------------- -- _-------------- ------- DATE a- r�` -------- <br /> REVIEWEDBY - --------------- ------- -- --------------------------------------------- ----- DATE------------------------------------- ---------.------ <br /> BUILDING PERMIT ISSUED------- - --------------------------------------------------_---- ------------------- ------- DATE---- --- ------- -------------------------- ------------- <br /> Alterations and/or recommendations:-------- ----.. -- ---------------- _----------------------------------------------------------------------------------------------------- <br /> --------------- ---- -- ------- - - - - -------­------------ -- -- - - -- ---- <br /> FINAL INSPECTION BY j`?6 _ . .... Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hacelton Ave. 300 West Oak Sheet 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi California Manteca,California Tracy, California <br /> E.H.9 2M 1.67 Vanguard Press <br />