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FQ,R OFFICE USE:j-30 <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> .... ...... <br /> -- ----------------- <br /> ---- --- ---------- (Complete in Duplicate) Date Issued <br /> ------------ 4-11 ----- --- 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 /> JOB ADDRESS AND LOCATION----------- ------1��o.......... --------------------------------------------- ------------------------------------- <br /> Owner's Name--------A/k/n d..,X_6-----4�g._110 ------------- -------- Phone------------------------------------ <br /> ---- ------------------------------------------------------- <br /> 7 <br /> Address.................................//--.-e------- ................. --------------------- ---------------------------------------------------------------------------------------- <br /> Contractor's Name-------------- A-------- ---------------------------------------------- ------------------------------------ Phone................................... <br /> Installation will serve: Residence E90"'Apartment House [] Commercial r! Tralier Court E] Motel El Other E] <br /> Number of living units: ---t N ber of bedrooms Number of baths,;?�---- Lot size --- <br /> ----------_------- <br /> Water Supply: Public system ;�?:unity system E] Private Ej Depth to Water Table4r_ ft. <br /> Character of soil to a depth of 3 feet: Sand [] Gravel F] Sandy Loam F-1 Clay Loam�E] Clay El Adobe [T'-Hardpan 0 <br /> Previous Application Made: (If yes,date--------------------) No gEr/ New Construction: Yes Egl"No E] FHA/VA: Yes E] N o <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-------------Distance from fourjdafion._,o!;q------------Maferiai-Ad,4-oov!oil/-------------_--------- <br /> VNo. of compartments------Iel- ------------Size---e-;FIIVVf �---Liquid clep�h_'_P------------------Capacity._A),-_Q_-6----- <br /> Disposal Field: Distance from nearest well----—---.--Distance from foundationZ. t-------..Distance to nearest lot line... <br /> G2__ Number of lines----------�Z--------- -----------Length of each --------Width of trench_AQ_10----------- --------- <br /> Ae—w-Depth of filter material------)f-"1 .4 <br /> ------ ------ ----Total length--- -- - ---------------------------- <br /> Type of filter material-ill-" <br /> Seepagp/Pif: Distance to nearest well------—----------DistanceiLom fgundation-Z-!q...........Distance to nearest lot line-.f-.'-/--------- <br /> Number of pits.---t1l------------Lining maferia1__A:::110__1__4-------Size: D ia mete r__ --------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation---------- ---------Lining material...... ------------------------------- <br /> 171 Size: Diameter--------------------------------------Depth---------------------------------- -----------------Liquid Capacity_--------------------------gals. <br /> Privy: Distance from nearest well-------------------------------- ----------------Distance from nearest building------------------------------------------ <br /> Distanceto nearest lof­1irre------------------------------ -------------- ------------------------- ---------------------:----------------------------------------------- <br /> Remodeling and/or repairing (describe):--------------2�_ --------- <br /> --------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------ ---------- ------------------------------------------------------------------------------- <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)----------I-el..... -,.. - ----------------------------------------------------------------------------------------------- (0 ner and/or Contractor) <br /> By:_ ...... .......1111-1061 "o------------------------------------------------------------------ ----------------- - ---- --------- <br /> --- --- ------- <br /> . loca <br /> (Plot plan, showing size o location of system in relation to wells, buildings, etc., can 6e placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----0__--- --------------------- ------------------------------------------- DATE_._+,�.1_4--- ------------------------------ <br /> REVIEWEDBY------------------------------------------------------------------------------- --------------------------------------------- DATE-------- ------------------------------------------------ <br /> BUILDINGPERMIT ISSUED--------- ----------------------------------------------- -- ------------------- ------------ DATE------------------------------------------------------------ <br /> k - 10A, - - <br /> Alterations and/or recommendai4ons:___,q__-__#__S------(a-S-----------j_51----- r--- -------------e_1&,d'%A------ -------------- <br /> 04 _1L_ <br /> ---�j�_ -- ----- ----------------------------------------------------------------------------------------------------------- k-PA;ws <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------- <br /> ------­-------- ------ ----------- --------------- --------------------------------------------------------------------------------------------------------------------- -------------- ....... --------------------- <br /> --------------- -----------_------ ------- --------------------------------------­­-------- ......-----­------- ------------- ------------ ---------- ---------------------------------- ----------------------- <br /> FINAL INSPECTION BY:---- --------------------------- Date---------- ---------- -------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazolton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.00. <br />