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FOR OFFICE USE: <br /> .. <br /> ------ -- ------ ------- Permit No. . _Q--�Q_.... <br /> ��_-� � �. c-� ����� APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) Date Issued <br /> This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. 4 <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND OCATION_ - ---- -r '''` '� `r- <br /> Owner's Name---- lt �� � � � = <br /> ------------- <br /> Phone.---•------•--------- <br /> Address---------- P-1----------- <br /> �------------------t-----------------�------------- ---------------------------•-------------------------- <br /> Contractor's Name--- 4x -------�/ � /� --'------------- -----------------=---------- ---- ------ Phone----------------------------------- <br /> Installation will serve: Residence F&�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __/_- Number of bedrooms ._ Number of baths -/-- Lot size -- ----------------------- <br /> Water Supply: Public system '❑ Community system El Private �epth to Water Table ft. <br /> Character of soil to;a depth of 3 feet: Sand ❑ Gravel I❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe❑ Hardpan ❑ ► <br /> Previous Application'Made: (If yes,date--------------------) No ❑ New Construction: Yes [I Na El FHA/VA: Yes El No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material_--__.---..--_.__.______----_____._....__------. <br /> Liquid de th----------------- -------Capacity <br /> J��'TL-� No. of compartments------------ -------- -size---------- ------------- ---- - q P� ----- ------------ <br /> Disposal Field: Distance from nearest well..� ..---Distance from foundation___�.2_____.._.Distance to nearest I� line_________________ <br /> c <br /> g, — ' A Number of lines--------.�-----�-----------------Length of each line------------- Width of french-A-11 <br /> of filter material - e'- epth of filter mat erial..._xe_--------Total length------- =. <br /> Seepage'Pit: y. Distance to'nearest well--/ -__Distance fro foundation_-_1� _ -_.Distance to nearest lot lie_-._____.- <br /> , ' ` /- � �{ <br /> * Number of pits----.-------------Lining materia l._.!?=I♦G�' -Size: Diameter-� --- -------Depth <br /> Cesspool: 1 fiom nearest well---__--.-___.._-Distance from foundation------------------- Lining material------------------------------------- <br /> Distance � <br /> ❑ t° Size: Diameter------=------------------------ <br /> ---- ------------- be,oth---------•------------------------ ------------ Liquid Capacity ------------ gals. <br /> Priv Distance,from nearest well------------------------------------------------Distance from nearest building. -:---------------- - 7 <br /> ❑ Distance tofnearest lot lire-- ------ ----- f ----------------------------------------- --------------------- 0 <br /> ---------- <br /> 7 <br /> �- <br /> Remodeling and/or repairing (describe)----------------- ----- . -------------- - <br /> -- ------- - <br /> ji <br /> y _ ' - —_ _ __________________________________ ___________ ________________________________________________________ <br /> _______________________ ----------------------------------- <br /> ____________i___•_________.______ _____-----------------------------------------__________.___.__.__-__- -------------------------------------------------- <br /> I <br /> _ __ ______..-_______________.-_..__.___ .__-_..-___._.___._.____----------------------- <br /> ....___.___..__._ <br /> __ __ <br /> I hereby certify that_-._ � k.4, _ _________________________________________________________________ <br /> - - - <br /> y y at I have prepared this application and that the work will be done in accordance with Sari Joaquin County <br /> ordinances. State laws, and rules and regulat' ns o the San Joaquiri ocal Health District. <br /> ' �.. t ✓ �or Contra'tor) <br /> (Signed)----. - - --------- ------------- --- ----- <br /> (Titl ------ <br /> J- <br /> . - � <br /> (Plot plan, showing size of lot, location of sys+e relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTEC? BY__..-__. <br /> ={ -� ~ DATE----- •--- ---- <br /> REVIEWEDBY------------------------------------ ---------------------- ----------------------------------------------------------------- DATE------ -------------•------------------------------------- - <br /> BUILDINGPERMIT ISSUED-------------------------------- ----- ------------------------------------------ ---------------- DATE------------------------1 --------------- ------------------ <br /> / -------1------------------ G" <br /> Alterations and/or recommendations:.------Z' �-- - -=--6 �';--------- ----------- --- - ------ ------------------------------------ <br /> --- ----- <br /> ------------------.------ <br /> c-E' ,t. -...—c--�� i"''r'" ---- --F --- ' -`f------------ �......----1--5--'---------4-'--`=----' ��-�• ^ <br /> --------- -,�-# r .: . <br /> ------- <br /> ---. ----------(.7----- <br /> -------------------------------------------- <br /> ---------------------------------------------------------- <br /> -------------------------- -------------­ ------------------------------------ ---------------- --------------------------- ----------------------------------------------- <br /> - Date - - <br /> FINAL INSPECTION BY:--------- ------------ ------ ------ <br /> -- -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 16o1 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California yam. Lodi,California Manteca,California Tracy,California <br /> • F.P.Cfl.• Ls.Vie+-'-. ; � t - Y ,,, - <br />