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FOR OFFICE USE: <br /> --------------------------------------------------------- <br /> ._-_______._.___. ._ APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------------------- -V------------------------ (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. 51�49. <br /> JOB ADDRESS AND LOCATION_'iiff,-41�a------4�Y <br /> ------------ <br /> Owner's <br /> ----------Owner's Name - <br /> - ------------- ------------- <br /> -- ------------- Phone.................................... <br /> Olt <br /> - - -- ----------- - - <br /> Address........... <br /> '�c' �'•2 <br /> Contractor's Name. -- -- ------ ----- -•---•------------------- Phone. <br /> Installation will serve: Residence ?Apartmen House ❑ Commercial ❑ Trai r Court ❑ Motel ❑ Other ❑ <br /> Number of living units: /--.- Number of bedrooms -3-- Number of baths Lot size ---../opt-�._,(-2 <br /> -----------••------. <br /> Water Supply: Public system ❑ Community system ❑ Private Ix Depth to Water Table<fQ- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Al Hardpan ❑ <br /> Previous Application Made: (If yes,date---------_ --------) Nox New Construction: Yes ❑ No X 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---- -Distance from foundation----/4r.-._----Material---- <br /> No. <br /> rial <br /> No. of compartments . „--------------Size__-_ X.��-�.Li Liquid de th__ � � - C <br /> � <br /> a aci <br /> v <br /> Disposal Field: Distance from nearest well_-------.Distance from foundation. 4__ Distance to nearest lot line__.:___.._.. <br /> Number of lines----- _---___.._ __ Length of each line_Fr_ "�-_'.LO.Width of trench---A-Cte--`�_________________ + <br /> Type of filter mate ria 1-4f40-04--------Depth of filter material--,eV- ---"e-------Total length �- <br /> th---- d�------------------------ <br /> Seepage Pit: Distance to nearest well.-/00! ------Distance from oundation_„e!�°?._�______.Distance to nearest lot line--ss` <br /> Number of pits__s2�__-_-__---Lining materiaL� ____-Size: Diameter-_t-j--'0*-------Depth----sl-.T._'-------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----------.-_-_---.-__-.-___-_-_----. <br /> ❑ Size: Diameter.---.------------ -- --------------Depth--------------------------------------------------Liquid Capacity-------•---- <br /> -------------gals. <br /> Privy: Distance from nearest well-------------_-----------------_------_----------Distance from nearest building <br /> ❑ Distance to nearest lot line------------------- - - - <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 C <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ounty <br /> (Signed)------------------------------------------------------------ _____.__.-(Owner and/or Contractor) <br /> � ----------- <br /> BY: L ---� -R"'�------- 'a°G Title <br /> = ( 1 -------- ----------------plan, showing size of lot, ocatio of system relation to wells, buildi s, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.____ _ -_ DATE- <br /> -- ----------------------------------- yfl_f <br /> REVIEWED BY DATE <br /> ----------------------------------------------------------- <br /> UILDING PERMIT ISSUED---------------- _ DAT .__ <br /> ------------------------------------------------- <br /> Alterations and/or recommendations:..___._!�___�* l�_- ---__ � f�' <br /> '' ? �V---- cam. ------ <br /> ----------------------------------- -------------------------------------- <br /> FINAL INSPECTION BY: ._. b <br /> - P�---- . Date - ---------------------------------- <br /> ��� <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street <br /> 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />