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FOR OFFICE USE: <br /> -- -"._�.---- .ti Permit No. (� `. .d.. <br /> _ lets=m.Du tate APPLICATIQN FOR SANITATION PERMIT <br /> -.... - <br /> This Permit�l`xpires 1 Year From Date Issued �- Date Issued <br /> A lication 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 compliancewith County Ordinance No. 549. / <br /> JOB ADDRESS AND LOCATION.--- _ -- -- -- <br /> \ /-----------------------•----•- -- .. <br /> Owners Name---------- - - -- -- <br /> ------------------ - ----- Phone.� 1-=- !.7 .. <br /> _. ------•--------•----- <br /> Address-.-------------------------•- rrtc`�-�----------- ---- --------------------••-------------- � <br /> t , Phone. .. -- <br /> Contractor's Name" __. �` ❑ <br /> Installation will serve: Residence�Apartment House ❑ Commercial ❑ Trailer Court Motel Other ❑ <br /> . Number of baths .. of size .---- - <br /> .-._ Number of bedrooms .. -- ---------------------------- <br /> Water <br /> --" ----" "-"--'---------- <br /> Number of living units: .- - ---- <br /> Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water,Table 4tv ft <br /> Character of soil to a depth of 3 feet- Sand El Gravel ❑ Sandy Loam ❑ Clay Loam ElClay ❑ Adobe lam. Hardpan ❑ <br /> Previous Application Made: (If yes date_. "� 1 No E] New Construction: [-]Yes <br /> No FHA/VA: Yes El No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: " <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Distance from foundation_._0-_..-....Material _ ---------- ---- <br /> Septic Tank: Distance from nearest well-l�ION�"_ e � ,, . <br /> No. of compartments. .Size _7� ---Liqui depth.... . - Ca act 1;?_,Ov 1_5 <br /> d - -- P Y <br /> t <br /> Dispo I Field: Distance from nearest well("{QK�.-Distance from foundation.-./.0..r--.....Distance to nearest lot line---��­ <br /> / <br /> _ <br /> f ,------------- ---- -- - --Length of each'line.. -- v�0.-------Width of trench..+ _ ��--------- ---•-- <br /> Number of lines... _ �. <br /> Type of filter material_" ' Depth of filter material__ /.g--"/ <br /> .. - . ._....._Total length___.... ""_"..__jr1l _____--•-- <br /> Se epa e Pit: Distance to nearest well...Not-g-------- <br /> Distance from foundation `__-.___Distance to nearest lot line_.---If <br /> Number of pits--- - `- -- g - �..�------ Size: Di meter---- - -��- Depth-l <br /> �- ---- -- --- Linin material _ CG # t�----- - P ��----•-------------- <br /> W <br /> - ----------- W <br /> ' -_. .Distance from foundation............."... ..Lining materia------------- <br /> Cesspool: Distance from nearest:,well ..__..._. <br /> Size: Diameter Depth- ;. :e. .Liquid Capacity----------------------- gals. <br /> F1 ; <br /> ---....__-...Distance from nearest buildin ------------------ <br /> ------------------- ---- <br /> Privy: Distance from nearest well_.......-".".___....-__".._.____.- t I <br /> ❑ Distance to nearest lot line---------------------- - --- I -- --------------------------r- -------- <br /> Remodeling and/or repairing (clescribe�:.._._- `-` - <br /> � Q. - ------------------- <br /> --------------- <br /> ------------ <br /> - i <br /> �- <br /> -------------------------------------------------------------------------n---------------------------------------------------------------------------.. r.: _- ------------------------------ r <br /> a„r s ''- - <br /> # ----------------- -------- --------------------------------------------------•----------------------------- --- --- ------ <br /> I hereby certify that I have prepared(this application and that,the ry�ork will be*done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Ht altlitisfrict. - <br /> f ]� , _VC, <br /> w <br /> (Sign >� ._ �" �_ � �?/' �7 ._ .- w��Contractors <br /> uke-- g 4 <br /> r :, ------ t <br /> �A - <br /> (Plot plan, showing size of lot, location of system rin Felaf' ;to wells, buil --- <br /> g's etc., can be placed on reverse side). <br /> F4R1;DEPARTMENT3USE ONLY 1 <br /> APPLICATION ACCEPTED BY--------- ..._ .� .. .---------- -- -------------- DATE �r �Z <br /> REVIEWEDBY----------------------------------------------------.:-------------- ------------------------ ---------- ------- -------- DATE - <br /> BUILDING PERMIT ISSUED-------------_--_-------------------I--------- DATE - <br /> Alterations and/or recommendations:----- �1- . - ------------------------------------------------------------- <br /> - -- =--- ----- -- - <br /> k:_- - ---- -------------------------------------------- ------------------ --------------------------•---------- <br /> :. /r _ -.- <br /> 1 CTJ--.. gip— `f"'_ --------------------------------- __............. <br /> -------------- -------------------------------.----------------- ------- ---------------------- <br /> Date ---- -�--- ��------�--b.-'--•- ----- --------- ----------- ----- <br /> FINAL INSPECTION BY:-...._._. -C -------- - r: <br /> _5 <br /> r SAN JOAQUIN"�C L HEALTH DISTRICT <br /> 1601 E.Noxetkon Ave, 304 West Oak Street 124 sycamore Street 205 West 9th Street / <br /> Stockton,California <br /> Lodi. California Manteca,California Tracy,California <br /> � <br /> ,_,_ E.H.9_)A 1-67 Vanguard Press <br />