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` FOR OFFICE USE: <br /> I -- ------------------------ <br /> ---------------------- <br /> -------------------------------- ----------------------- <br /> APPLICATION`FOR'SANITATION PERMIT Permit No. .. _.._. <br /> I (Complete in Duplicate) <br /> �~ --.- This Permit Expires 1 Year From Date Issued Date Issued _______ <br /> F 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--------------------- --- We5it <br /> ' <br /> 411W JA��r <br /> -------- <br /> -- f_ <br /> i -Owner's Name------. -------------- - ---- ----- <br /> Phone-- <br /> Address-----•---- D�--- . ^ .... <br /> Contractor's Name---- - 19,170 � _ ----4%5V!t ----------------------------------- --------------•-------------- ----•--- 1� <br /> Phone. �1?7.--. <br /> ?7-- <br /> Installation will serve: Residence A artm House Commercial Trailer Court ❑ Motel ❑ 0ther <br /> ins �p ❑ ❑ <br /> Number of living units: ........ Number of bedrooms -01-- Number of baths ----I_ Lot size ____lQ_ __pl�� ____..__ °-�� <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 40-- ft. - <br /> Character of soil to a depth of 3 feet: Sand E .1 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,dote....................) No ❑ New Construction: Yes X No ❑ FHA/VA: Yes ❑ No <br /> I TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> {No septic tank"or eesspobl„perrrsitted'ii#pui/lie-sa el"is-vaH;Fblb-within4200#eet} <br /> Septic Tank: Distance from nearest well...... Distance from foundation------- -,Material----Z90 <br /> ..��.� <br /> > [ No. of compartments--------- 2—----------Size----g�_y..6___---- --Liquid depth--------V1............Capacity----el4Pop-e^ <br /> Dispos Fi Id: Distance from nearest well--,e_�._Distance from foundati ,�a-- i. ante to nearest lot line____-..... <br /> - Number of lines_________�f�'[------ Length of each line_- -r' ------Width of trench____-. <br /> Type of filter material----4r _ ,vrf+-DEpth of filter. mat erial-___._/1__-..........Total length-----_-------------l ___.____________ E <br /> } Seepage Pit: Distance to nearest well----------------------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------------------- 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 /> Remodeling and/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 and regulations of the San Joaquin Lo4tal Health District. <br /> l _ <br /> Y <br /> (Signed)--------------------- - --- ----------------------------- - - - --------------- - ------ ---------------- -- <br /> -= •: - Owner'�an-,dr�'or Contractor) <br /> (TitlgY loc -la(Plot plan, showing sizeof lot, - n eaton to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEP RTMENT USE ONLY <br /> APPLICATIONACCEPTED BY-- ----- ----- ------------------------ --------------------------------------------------- DATE------ ------------------------------- <br /> REVIEWEDBY-------------------------- ---- ------------ --------- ---------------------------------------- •---------------------------- DATE------ ---------------------------------------------- <br /> BUILDING PERMIT ISSUED------------------------- ------ DATE----------------------------------------------- ------------- <br /> Alterationsand/or recommendations---------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------•----- ------ -------------------- -------------------------------------------- -------------------------------------------------------------------------------------------- <br /> ------------- ----------- ----- ---- --- --------------•-------- -------------------- -- -------------------------------- ------------------ -------------------- ------------------ -------------------------------- <br /> --------------------------------FINAL INSPECTION 1 :47-------- <br /> Date --------------------------------- <br /> ----------------- <br /> r SA AQU1N LOCAL HEALTH DISTRICT <br /> 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.a.co. <br /> I <br />