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FOR9FFICE USE: <br /> APPLICATION .FOR SANITATION PERMIT Permit No. <br /> __- ---_._.._-.--- (Complete-in Duplicate) <br /> Date Issued <br /> .____. -- --------- -_ This Permit Expires 1 Year From Date Issued <br /> lApplication is hereby made to the San Joaquin Local Hea=th 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 /> JOS ADDRESS AND LOCATION.---�-- -�---�- -- -------"r-----.5t�------------------------------��--//-�------------ ------- <br /> - <br /> Owner's Name +----� w------------------------------ ------------------------------- ------------ Phone__4k5_3% '-- <br /> Address., •------- ----------------------------------------­­ -----•------------------ <br /> Contractor's Name ®LPf77 � Jam-. ------- -- ----------------- Phonee �_([� +(p <br /> Installation will serve: Residence �artment House ❑�,/Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: j---- Number of bedrooms _iv_. Number of baths _%---- Lot size -------------- - <br /> Water Supply: Public system .( Community system ❑ Private ❑ Depth to Water Table 46.0 ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe id Hardpan ❑ <br /> Previous Application Made: (If yes,date................... J No ❑ New Construction: Yes El No FHA/VA: Yes E] No E] <br /> i TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank.or cesspool permitted if public sewer is available within 200 feet.) <br /> Septi Tank: Distance from nearest well--m-mv—-------Distance from foundation---19M_......... terial ---' <br /> No. of compartments__.---------------Size <<�[ quid depth__'.+..... ..__._..Capacity__ ��_ _ <br /> D's al Field: Distance from neares welL._mr_-;__-.-Distance from foundation_ _ s <br /> �Q_._.__.._.Qistancs to nearest lot line____-_ <br /> Number of lines._____I._.__._.. '�4--_- Length of each line__ ---- �- ----Width of trench------ r�7 -----.--_- <br /> Type of filter materiall & ..'._Depth of filter material____._L--- (-----Total length-----------------C��le <br /> f � 3 <br /> E See a ES E: � Distance to nearest well r____ __..;___-.Distance from foundation--------------------Distance to nearest lot line----------..--_-- 1 <br /> Number of pits.-- --- .--Lining Size: Diameter-----------------------Depth_...------ --------------------- <br /> Cesspool: Distance from nearest well ---------f______Distance from foundation ------------- ..Lining material__________________ __________________ \ <br /> I ❑ Size: Diameter- -- -------- ----- ----------------Depth----- ----- - -------------------------------------Liquid Capacity------------------------- -gals. <br /> Privy: Distance from nearest well............ ...---------.F----------------------Distance from nearest building-...---.-..--------------_-_---._ <br /> ❑ Distance to nearest lot'line ------------------------ <br /> Remodeling and/or repairing (describe :......................t-------------------------------------- ------- ------------- ------------------------- ------------------------------------ <br /> -------------------------------:---------- -------------------------- ------'------------------------- ------=-----------------------------------------------------------------------_------------------- <br /> •. <br /> ---------------------------------------------------------------------------------------------__�___.----.---__--__+.'_q_-._-__-___-_-_-___--------_--------.------------­-----------------_--_.--__._._-._._-_-_.-_----_._- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> I ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> t <br /> (Signed)---- �1 .` - 1. - - -` r Contractor) <br /> $y:-------------------------------- ------------------------------ Z.Q - 411 - <br /> (Plot.plan, showing size of lot, location of system in relation to wells, buildings, etc., can be .placed on reverse side). <br /> i <br /> FOR DEPARTMENT USE ONLY <br /> I . . <br /> Q- <br /> APPLICATION ACCEPTED BY'=------' s " `L -------------- ---------.--.--•------- DATE....:(.. .�Jr .............. <br /> REVIEWEDBY-------- -------- ---------------------------------------- -------- - ----------- -------------------------------------- DATE------------------------------- <br /> BUILDINGPERMIT ISSUED-------- ------------ ------------------------------------------------------ ---- ------ ---------- DA-TE---------------------------------- --------- ----------- - <br /> Alterationsand/or recommendations:----- ----------------------------------- -- - -------------------------------------------------------------------- -- ------------------------------------- <br /> "I I'- <br /> - --------•---------- -------------_ ....------------------------------- ------ ----- . ....... <br /> FINAL INSPECTION BY:.. / .d_- -/i/.h--/.. ._ �� Date- /--F .. -'..- '...f . ----- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> $ 5fockton,California Lodi. California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />