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'FOR OFFICE USE: <br /> -------------- -------- --------------- -- ------------- ' <br /> APPLICATION FOR ,SANITATION PERMIT Permit No. <br /> ----------------------�--l- --- ---------------- <br /> -------------- _ <br /> ---__---_-__---_---4- 1---- --- (Complete in Duplicate) Date Issued <br /> --------------------------------------------------------- This Permit Expires 1 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.........41 D IyT _I�US---------------------------------------------------------------------------- ..---- <br /> Owner's Name-------- -------------- .......... ---------------------------------­------ ------------------ Phone------------------------------------- <br /> Address -- ---- <br /> -E-e'--�----- <br /> ------ <br /> -------------- --------- -------IS <br /> Contractor's Name----------C- _rZT-I---F--)---(•Q--------)--�C. -------� E121-,------------ Phone----------------------------------- <br /> Installation will serve: Residence I Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ---i--- Number of bedrooms --- Number of baths ---I---- Lot size ---1-0.0_____________________________ <br /> Water Supply: Public system 'N Community system ❑ Private ❑ Depth to Water Table _6! ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeX Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No A New Construction: Yes No ❑ FHA/VA: Yes ❑ No i <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.)_V.01/_C_Distance from foundation---40.- ...._._..Materi I.__�efr.'NaleC7_-------------- <br /> No. of compartments..____--t__.__-_-_.Size--- JC,S_-_. __, ..._..Liquid depth-----$4_7------------Capacity_-. <br /> Disposal Field: Distance from nearest well-N0!16Distance from foundation..-/p.._..__.Distance to nearest lot line............ ... <br /> Iry . --- of each line-...._. ..Y1-�.............Width of trench..__..-.. '�--�...._..- <br /> YN Number of lines_._.__..__.I.. ... . � <br /> Type of filter materiaO. _��Q l_E___.Depth of filter material-------lt_"_-------Total length.......................4F---------- <br /> Seepage Pit: Distance to nearest well--------------�t.._.:Distance from foundation....................Distance to nearest lot line----..-------...- <br /> ❑ Number of pits----------------------Lining;material----------------------- Diameter--------------- -------Depth-----.-----------,--------__...._ <br /> Cesspool: Distance from nearest well-----------------Distance.from foundation.-----------------..Lining material------------------------------------- <br /> ❑ Size: Diameter-.---------------------- -----------Depth-----.-------. -------------------------------------Liquid Capacity------.--------------------gals. (� <br /> Privy: Distance from nearest well-------------- i-- - - . ___-_.__Distance from nearest building------------------------------------------ <br /> ❑ Distance to nearest lot line----- ------------------------------------------------------------ ------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):--------- ------ - --- -----ter-x Es-4�.... -•,' -- - •--•-------------------•---------------••--•--------•---- <br /> ---•---------- ----------------------- <br /> I -------------- <br /> r �that <br /> �-- <br /> -I hereby certify that I have prepared is a_ p tion the wont 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 /> n <br /> (Signed) = (Owner and/or Contractor) <br /> By------------------ ------- --- -------------------- 1------------------------.(Title)--------- ------------------------- -- ---------- <br /> (Plot plan, showing size of lot, location of system in rection to wells, buildings, etc., can be placed on reverse side).. <br /> FOR DEPARTMENT USE ONLY / <br /> APPLICATION ACCEPTED BY ------------ -------------------------------------- DATE- , / f `r- <br /> REVIEWEDBY---------------------------------- ------------------------------- ---------------------------------------------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED----- -------------------------------------------------------•-------------------------------------. DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:------- --------------- --------.-------------------------------------------------------------------------------- <br /> -------------------------------------------------------•------------------------------------ ------------------------------------------------------------•------------------- ------------------------------------------- <br /> ------------------------ <br /> ----------------------------------------------- <br /> / - <br /> ------------ -------------------------- � �`'CJc' -------------------- - <br /> . = ��_ ----------------------------------------------------------------------------------- ------------------- -------------- -------------------------------- <br /> FINALINSPECTION BY--------- --------------------------------- - Date-------------------------- ---_---------------------------------------------- <br /> SAN 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 /> P.P.CO. <br />