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FOR OFFICE•-USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No. <br />___________________A <br /> (Complete in Duplicate) -3/� /� <br /> This Permit Expires 1 Year From Date Issued Date Issued _____________y___l� <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein d � <br /> This application is made in compliance with County Ordinance 549. r <br /> JOB ADDRESS AND L CA ION..... ____ , <br /> Owner's Name------ _�----- ( d--- �------------- r -------------------fro <br /> F 1,70 <br /> Phone <br /> Address ( .. 1,./ tT �f� ­ � �f <br /> Contractor's Name sj'Q------. 0.C�_ ,Z - Phone <br /> Installation will serve: Residence Wl-�A`partment House ❑ Commercial ❑ Trailer Court Motel ❑ Other ❑ <br /> Number of living units: ___f__ Number of bedrooms _-9/ Number of baths _ Lot size <br /> Water Supply: Public system ❑ Community system ❑ Private �pth to Water Table _. . ft. <br /> Character of soil to a depth of 3 feet: Sand [Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe© Hardpan ❑ <br /> Previous Application Made: (If yes,date_------------------) No Pll_�ew Construction: Yes gj- o❑ FHA/VA: Yes ❑ NoEj-- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) -- --- <br /> Septic T Distance from nearest well_____--Distance from founclation___/O ___-_Mat ria__ / ------..._ ------ <br /> EV No. of compartments.3---------------___Size_yt/.� Liquid depth___�j_ ........... ----Capacity__._. <br /> Disposa field: Distancfrom Numbee of lines nearest well__._..._Distance from foundation____-_s _. .___--.Distance to nearest lot line .f._._._____ <br /> Length of each line_,/1,�►J/0-0 Width of trench-------�P,�_____--------- <br /> Type of filter material__'/____Depth of filter material____� i_________Total length__Q__ _:--_ <br /> ------------------ <br /> Seepage Pit: Distance to nearest well____ __ ___________Distance from foundation_ __________ Distance to nearest lot line----------------- T❑ Number of pits__.__ _____._ _____Lining material------------___-____-Size: Diameter _, __-- Dept+` ______ --------------------__ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining materiae__.__.__________________-_______ V1 <br /> ❑ Size: Diameter--------------------------------------Depth--------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well------ ----------------------------------.-------Distance from nearest building------___-__________________._.______- 3 <br /> ❑ Distance to nearest lot line------------------------------------------------------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe)---- ------- ��Ic_ ,� :;2_ '✓----•- ---- ---------------- <br /> ------------ <br /> -------------------------------•------------------------------•-----------•--------------------- �Ic_ _:;2�_� <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) �� ----------------------------------- ---------------------------------- - - -----(Owner and/or Contractor) <br /> By--------- L:IL = ------------------------ (Title) - <br /> --- -------- — <br /> (Plot plan, showing size of lot, ion of system in relation Is, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----71R_0--------------------- -------------------------------------------------- DATE-----3--;i� - /5 --------------- <br /> REVIEWEDBY-------------------------------------------- -------------------------------------------------------------------------------• DATE----------------- ------------------------------------------ <br /> BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------- --_------------ DATE----------------------------------- --------- -------------- <br /> Alterations and/or recommendations:-___.-ISL-L_____ ___/f�CSTF}G - LA7----------- F'__._-------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------ __---� <br /> ---------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------ <br /> •-- -- ------ - <br /> FINAL INSPECTI B J - Date3--23-- -0 <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 />