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FO FFICE USE: <br /> ----------------------------------------- / <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> -- ----------- ------------- <br /> o? cold <br /> (Cor-*plete•in Duplicate) <br /> - This Permit Expires 1 Year From Date Issued Date Issued .1 __-_ __��� <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. �A <br /> JOB ADDRESS AND LOC ION-------Z(�P,� ---------I(}�_!Q------- �--------------------------------------M -------- <br /> Owner's Name----------------------JAM <br /> M'S...------1J'�_�+ f -----®- ------- - --------- .. Phone------------------------------------ <br /> Address-----------------------•� +tom. (ZI T/,moi--------R-b--_----------1 � -------------------------- ........................................... <br /> Contractor's Name--------OW E - ` ---- --------------•--------. I--------------------- Phone........--.--••-------------_------ <br /> Installation will serve: Residence (Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: --I-_-_ Number of bedrooms _I--- Number of baths _1-___ Lot size ___ R0.. _ A1?j4-TIj0_Aj.° <br /> Water Supply: Public system E] Community system ❑ Private J]/Gepth to Water Table ft <br /> Character of soil to a deoh of 3 feet- Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Mader.. (If yes,date------------------- ) No Er-New Construction: Yes gR­15o ❑ 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_..____ -_.Materi I __ .. _.-... <br /> ]/ No. of compartments___.. ___ ---Size_3__X_'7A__ __Liquid depth___'___Capacity-_V00--- <br /> Disposal Field: Distance from,nearest well----5Q...Distance from foundation-----1Q---------Distance to nearest lot line___ ... <br /> Number of lines---------I----------------------Length of each line___-?Q.`__��__._.Width of trench-------- __._-_.__e_.-_ <br /> Type of filter material__ _Q. ____Depth of filter material__.-.,(-_ ---- ------Total length__ ___._-.________-_•S0_____..__ <br /> Q <br /> Seepage Pit: Distance to nearest well---___--------_.......Distance from foundation--------------------Distance to nearest lot line-----............ 0 <br /> ❑ Number of pits--- -------.__._.-_.Lining material--------.------------- Size: Diameter----------------- ____Depth--------------------------------- 04 <br /> Cesspool: Distance from„nearest well ----------------Distance from foundation-----------.----- _.Lining material------------------------------------- N, <br /> ❑ Size: Diameter- -- ----- -- ----- ----------Depth------ ------=--------------------.-Liquid Capacity - -------------------gals. <br /> Privy: Distance from nearest well ---------------------- ---.-------_Distance from nearest building_4t--------------------------------------- <br /> ❑ Distance to nearest lot line-------=------------------=------ -- - - =; ':.----------------------------------------------------- -------- <br /> Remodeling and/or repairing (describe):------------------------- ----------------------------------------------------------------------- ------------ti-----------•------------------------•-- <br /> ------------•----------------------------------------- •------ --------- ------------_----------- <br /> ---------- --------------••---------------------------------------------------------------------------- ------------ --------------------•------------------- ------•-------------------------- <br /> --------- ----------------------------------------------•--------------------------------------------------------------------------------------------------------------•-------- <br /> ------ -------------------------- -- ------------------------- <br /> 1 hereby certify that I have prepared this application and that the work will be done in accordance wi.h San Joaquin County <br /> ordinances, St laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)------- ------ - — -- ------ ------- -- ---- ------- -------- - (Owner and/or Contractor) <br /> B -------------- -- - ------ --- -- ---- -- --- --- ------ -- --------- -----(T e)--- - ------ -- ----- -------- <br /> y• ttl <br /> (Plot plan, showing size of lot,'locatton of system in relation'to''Wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----------I t fl ��----------------------- ---------------------------------------------- DATE-----/�r '-- � ,R' --------------- <br /> REVIEWEDBY-------------------------------------------------------------------------------------------------------------------------- DATE----------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED--------------------------------------- ----------------------------------------------------------- DATE--------�;------------------- -------- --------------- <br /> Alterations and/or recommendations------------------ ----- ---- -------- --- ------------------- <br /> -----/_ <br /> FINAL INSP BY:. -- • --- ---- --- -- --- --------- Date......... l 'e----3Q.''�P�---------- --------------- <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 /> E.H.9 2M 1-67 Vanguard Press <br />