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FOR OFFICE USE: <br /> ------------------------------------------------- ----- ",-� .. <br /> Permit No. ... <br /> ;�_ -------------------- AI''PLICATION AOR SANITATION PERMIT-------------------- -- [Complete in Duplica+e} _ ► <br /> _ This Permit Expires 1 Year From Date Issued Date Issued _____.__ ____b_ <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 /> n Q �r �J , <br /> JOB ADDRESS ANppD��LOCATION__!✓t_J__�__�_ - _f/+-ur --------�r�-•_-� ��----- <br /> Owner's Name:- -'alez_. Phone <br /> •------------•-------f---,-------- ----------- ------------ <br /> Address---.-•----------_��r Ib.... =-------�-7-----------•------+/----""---------------------------------------------------------------------••--•-------------------------------- <br /> Contractors Name-------- + ----------------------------•--•--- Phone---------------------------------- <br /> Installation <br /> --Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __1_--."Number of bedrooms -j&__ Number of baths --- Lot size __ .v.. ------------------------------ <br /> Water Supply: Public system ❑. Community system ❑ Private ] Depth to Water Table _&rft. , <br /> Character of soil to a depth of 3 feet: Sand p Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe, ] Hardpan ❑ y <br /> Previous Application Made: (If yes,date----------- <br /> ___.__-1 No New Construction: Yes E No ❑ FHA/VA: Yes ❑ No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> x .,F R(Norsepticrtank_or�cesspool permitted-if-public sewer-is available wit hin.200 feet.] i T <br /> 'r-"X <br /> � W.,„c `n'owr".'"r '�-+*��""a" = --'^�' r- �" - •.rte .,; <br /> Septic Tank: Distance from nearest well---�Q-____Distance fi m foundation____-J__Q__-_-.-.Material__ <br /> d' ------------------------- <br /> p --Liquid depth--- Al------------------Capacity..kov--!------ � <br /> No..of compartments' <br /> am artments____. ............ .Size. _____�-r___.___ <br /> Disposal Field: Distance from nearest well.-5.. -------Distance from foundation----J_0----__._.Distance to nearest lot line---4------------ J <br /> Number of.lines------, -------- ----- - - <br /> ----_.Length of each line_.... -0'----------------Width of trench-__A.�=.'-------------------- <br /> Type of filter materia&_. C Depth of filter material---_./.?_`'.;..__Total -- <br /> - ---------------------- <br /> rest <br /> Seepage Pit: Distance to neaeel _____________________Distance from foundation---------------___.Distance to nearest lot line---.-.-.__--_-__- <br /> Number of pits----------------------Lining material---------------- - --.Size:.Diameter.----------------------Depth--------------------------------- <br /> Cesspool: Distance from nearest well--------------- -Distance from foundation---------------- _Lining material_---------------------------------.- ,�, <br /> ❑ Size: Diameter---- --------------------------------- -------------------------------------Liquid Capacity---------------:------- ,-gals.:Depth---- - = <br /> Privy:` Distance from nearest well---------.____________________________-- -.-Distance from nearest building-------------------------------- <br /> ----------- rQ <br /> ❑ Distance to nearest lot line- ------------------------- ------------------------- --------------•------------- --------------------- � l <br /> Remodeling and/or repairing (describe):----------y------------------------------------------- -------------------------=-------------------------------------------------------------------- <br /> ------ --------------------- ----------------------------------------- ------ <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 /> j/y (Signed)------------=--------------•--••---------------------------------'------------------------------------------------------------------------------------------------._.(Owner and/or,Contractar} z" <br /> S w <br /> '-By:- .x_ fes!/ Title) <br /> (Plot plan, showing siie of lot;location of sys+em in`rela+ion'ta wells,;b—u ngs;`etc.ccan`b.pla`ted-on°reverse'side)­ '=*--' <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY Y�Li1 ------------------------------------------------------ DATE------ -------------------------- <br /> REVIEWEDBY-------------------------------------------- ----------------------- ---------------------------- DATE----------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- <br /> Alterationsand/or recommendations-------- - ----------------- ----- '------•------------------------------------------------------------•------------------------•-------------- <br /> ----------------- ----------------- --. ------------ <br /> , , <br /> ------------ --- -------------------------------- ------ 1 <br /> FINAL INSPECTION BYe ------------- ------------ Date--- ------------------------------------------------ ., <br /> r <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> E5 9 REVISED 8-59 3M 3-'63 F.P.Cn. I <br />