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FOR OFFICE USE: <br /> /Z=AT=4s--------------- <br /> --------/ - _________------------ _( E!1 APPLICATION FOR SANITATION PERMIT Permit No. .-117 <br /> 1.. .. ...... <br /> A2- - - -0 ------ (Complete in Duplicate) <br /> __.___ This Permit Expires 1 Year From Date Issued Date Issued <br /> _. <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--------riC�- ------- ------------------------------------- <br /> Owner's Name------ •-- ----- ---may e.-J----- --- ----- ---------- -- Phone-----•---------•--------•----------. <br /> Addressc �vlz�----------------------------------------------------- --------------------------------------------- <br /> ----------------- <br /> Contractor's Name----------------------- -------- - Phone................................... <br /> will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other f],,, <br /> Number of living units: ----/__ N er of bedroo�--_ Number of baths ----/__ Lot size _/ /�______________ ________-._ <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table,,/7_ 4. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam ❑ Clay ❑ Adobe ff Hardpan ❑ <br /> Previous Application Made: (If yes,date__________________) No �ew Construction: Yes No ❑ FHA/VA: Yes V--60 ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) A <br /> Septic T k: Distance from nearest well----- Distanc from fo ndation/12--------.Mat riaLL-�� lG- <br /> -- <br /> No. of compartments--_--_'7/____._____Size___ ___ _,___Liquid depth----- -_%__ Capacity._. - --------------- <br /> DisposalFi Id: Distance from nearest well- _._._Distance from foundation stance to nearest lot line__._..... <br /> Number of lines------ ___ _Length of each line.__. ....Width of trench-__�_ �l--------------- (�) <br /> Type of filter material _ 2._. _-Depth of filter material__ '/---------Total length----- ,S /___________________ <br /> See^pag�e ,it: Distance to near well_____.' -.-._Distance om foundation-- Q__.......Distance to nearest lot lin_______--_-.-_ <br /> Lg' Number of pits..______Lining material_ .,;, _____Size: Diameter-3-3.'..._Depth _._---._--.-..-_--.. <br /> Cesspool: Distance from nearest well-----.-----------Distance from foundation------.-------------Lining material_ <br /> --..__-._--_--_-------------------. <br /> ❑ Size: Diameter---------------- --------------------De th--------------------------------------------------Li uid Capacity- ----------•---------------gals. <br /> Privy: Distance from nearest well -____.-___._____-------------.----------------Distance from nearest building______._-.______--_________.__.-___-. <br /> ❑ Distance to nearest lot line - = ----------------------------------------------------------------------------------- -------- <br /> Remodeling and/or repairing (describe):______._ lf%t%c1_-------- --------------------- -------------------------------- <br /> --------------------------------- ------ <br /> -------------------------------- -----� J ---------101 ---------- ------------------------------------------------------------------------------------------------------------ <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•-------------------------------- <br /> I hereby certify that lhake prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, d r s and regul ins of Oe San Joaquin Local Health District. <br /> (Signed) `-- _-_.__._(Owner and/ r Contractor) <br /> 01 <br /> BY:--------------------------- Tale <br /> --------t­_-Fu�, -�-_ ( � ) - ------------ -------- <br /> (Plot plan, showing size of o location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---------------= ----------------------•------------------------------------------------- DATE----- -Z,5�- �-= S.f..... <br /> REVIEWEDBY------------------------------ -------------- ------------------ -----------------------------------•---------------------- DATE------------------------------- <br /> BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------------------------- DATE----------------- ---------------------------------------- <br /> Alterations and/or recommenda 'ons________________-._.--__.__-.._____..___.___.____-.•_____________._._-__ ---- <br /> 2 <br /> -----------�'-'-6�--"-- --- -�'.-�f ----------------------�-------- -�------------------------------------------------------------ <br /> - <br /> -•-----� - ��--��,,pp ---- --�-------{,:--- ------- ,rte � . <br /> r --- `� o• <br /> - -� _ ' - <br /> - --- � . -- ------------------ <br /> ��-cy T� ......... �'------------------------ --------------- - <br /> FINAL INSPECTION 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 />