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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> 40­1 <br /> ----- - ----- -- ------- (Complete in Duplicate)------- <br /> - This Permit Expires 1 Year From Date Issued Date Issued .__.rte'J <br /> I <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,,: G '-t., rte[ . Z....... <br /> -yf <br /> Owner's Name----------0 1 ------rr Phone_.. <br /> Address------------• .6------ 0--3------ - _- ------------------------------------------------------------------------------------•........... <br /> Contractor's Name---- 7---- '= `---- Phone----------------------------------- <br /> _ -- - ----------- --- --------------------- <br /> Installation will serve: Resident. 3'�partment House [_1 Commercial E3 Trailer Court El Motel F] Other E]__f <br /> Number of living units: <br /> _Number of bedrooms -!!3--- Number of baths __ --_ Lot size __.1_. - - ---3- - --------------------•-----•- <br /> Water SuPPIY� Publics stem ❑ CommunitY system El � Depth to Water Table ft. I <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay 0 Adobe ❑ Hardpan <br /> Previous Application Made: llf yes,date-------------- ) No E] New Construction: Yes ❑ No ❑ FHA/VA: Yes No El <br /> TYPE OF INSTALLATION AND SPECIFICAk-flONSi <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well--.57'D------Distance from foundation <br /> - - foundation__.--F -P--'_ Material---_--- <br /> No. of compartments- - - depth----- . Capacity - -_-_-_-_- <br /> Disposal _ <br /> , <br /> Field: Distance from nearest well 0.-._:...Distance from foundation_-- -------:.--Distance to nearest lot line__S__.-_-_.- <br /> [, Number of lines______{^___ __ __._p _ -)-ength of each line___.___ '_._____-_._.Width of trench.---;c•. ;�'__________________ <br />{ �C Type of filter materi _ .- o!_t"_Uepth of filter material--- __17-k...._...Total length__-..�_.__ ----------------_--_----. <br /> _Distance from f undation____-.-b..._...Distance to nearest lot line��-----__..._ <br /> Seepage Pit: Distance to nearest we L-���__.__._ f <br /> 9 Number of pits._ .2------_---_--Lining material__--_.Size: Diameter-----3.3-'/-.--.--Depth--.�47------------------- <br /> I <br /> l Cesspool: Distance from nearest well-----------------Distance from foundation...-----------------Lining material__.------------.- .--___ <br /> ❑ Size: Diameter--------------------- -------- -------Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------- <br /> ❑ Distance to nearest lot line------------------------ -------- ----------------------------------- -------------------------- - <br /> Remodelingand/or repairing (describe):-------------------- -------------------------------------------------------------------------------------------------------------------------------- <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 a egulations of the San Joaquin Local Health District. <br /> { • - <br /> Ownerand/or C <br /> ontract <br /> or(Signed) <br /> BY:------------------------•-----------------------------''--------------------------------------------------------------------------.--(Title)---------------------------- <br /> - ------- -- - ----------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> BY_ <br /> APPLICATION ACCEPTED ___. <br /> ------------------- DATE--,-,?_7_ 7 70/-!------------------------- <br /> REVIEWEDBY------ ------------------------- --------------------------------------------------------------------------------------------- DATE-- •---- ----- --------------------------------------------- <br /> BUILDING PERMIT ISSUED----------------- ------------------- ---------- ------•---- .----- D ;E----- ✓ ---------- <br /> 01) Ir <br /> ---- -- - ---- - --- --- ---------------------------- -------- �' 6 - <br /> Alterations and/or recommendations:__-_ _. ..-__- ' <br /> ------------- ------ ---------- -------------------- ----------------------- ------- ------------------------------------------------------ -------- --------------------------------------------------------- <br /> ---- <br /> --------- - -- <br /> ---- - ----------------------------------------------------------------------------------------------------•------------------ ------------------------- <br /> --------------- --------------------------------------- ---------------------------------- ----------------------------------------------•------------------------------------------------------------------------ <br /> ---------------- ------------------ <br /> --------------------------------------------------------- ----------------------------I——------ ------------------------------------------------------I------------------- ------------------ ------ ---- ------------------------- <br /> FINALINSPECTION BY:.,,4----- -------------------- Date-- ....... ----- - -- --- -------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ha:ellen Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> St*cklon,California Lodi,California Manteca,California Tracy,California <br /> F.P.CO. <br />