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FOR OFFICE USE: <br /> --------------------------------------------------------- <br /> --.----_--_---------- - --------- -- -------------- APPLICATION- FOR SANITATION PERMIT Permit No. ..Iak.A l <br /> ------------------ ---------- (Complete in Duplicate) <br /> -� --- This' Permit Expires 1 Year from Date Issued 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. <br /> This application is made in compliance with,9!ounty Ordinance No. 549. { <br /> JOB ADDRESS AND LOCATION---'- R4-------- <br /> Owner's Name---------- �i �[,��1 ,e --------- 2--F_�----�-------------------------•----------•.--- Phone------------------................ <br /> ------------------- d�. -------- __ a <br /> lJ�` = - 7� <br /> ------------------- <br /> Address ------ <br /> Contractor's Name............ ---= ' /�'!�S' q� _ t�,�tL� .��1/ ------------------ ---------- Phone.- <br /> > <br /> Installation will serve: Residence Apartment House'[] Commercial. ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: 2 Number of.bedrooms -------- Number of baths -------- Lot size <br /> ater Supply: Public system ❑ Community system ❑ .private Depth to Water Table66rft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ San y oam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date____________________) No� New Const day <br /> Yes No E] FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: � �� _ <br /> (No septic tank or cesspool permitted if public sewer is avai able within 200 fee W. <br /> / E <br /> Septic Tank: Distance from nearest well________Distance from foundation----/_0___r___Material___--. .. - _____________________ <br /> No, of compartments:.-__•�--------------Size4r�_ _. d�__.___Liquid depth_ ",C_, _Capacity._- <br /> / f <br /> Disposal Field: Distance from nearest well... Distance from foundation__lL----_.......Distance to nearest lote.. .__ <br /> [ Number of lines------- _________Length of each line______ _EJ ` Width of trench__ ___ <br /> �/ <br /> 9 �` ---- rt <br /> Type of filter material-___.�_t"_e-_____Depth of filter material_----- --"--._._Total length____r�-_ -_--____-_________________ ._ <br /> • i le <br /> Seepage Pit: Distance to nearest'well-__/tQ_____.____Distance from foundation../.6_..........Distance to nearest lot line______ 5.f� <br /> Number of pits------r_____________Lining material.-_1ZV.G/_---Size: Diameter___,Pa`e__---_---Depth____2,S` <br /> Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material__._____-_.-__-__-_____----.____.___-. ` <br /> ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity_...__-•--------------gals. <br /> Privy:: Distance from nearest well-------------------------------------------------Distance from nearest building_____...___________-_----________ 9 <br /> ❑ Distance'to nearest lot line-----------------------------------------^ ------------------ --•- <br /> Remodeling and/or repairing (describe):------------------- ---------------------------------------------------•--------------------•------•--•------ <br /> --------------------------------------------=-----------------------------------------------------------------------------------------------------------------•--------------------------------------------------------------- <br /> -------------------I­ <br /> -----------------------------------------------I"-•-"----------- -----------------------•------------•----------•------ .-----------------------------------------------------------------------------------••---------------------------------- <br /> 1-hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules off re_ lations of the,San Joaquin Local Health District. <br /> (Signed)------- _-___ _.� / 1 1 /� "". � �rsd�^____ �.,1 ____.______.___.__.__ ------ and/or Contractor) <br /> BY ---------------- ---Y -/� ----------Title <br /> - - � - ( ) s - <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> F FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY- ------ ----------------- -------------"-- ---------- DATE------- <br /> s I ; <br /> BY-------------------------------------------------------------------------- ----- ` r - . DATE <br /> - ---------------- <br /> ----------------------------------- <br /> REVIEWED �- <br /> BUILDING PERMIT ISSUED -- . D AT ------------- <br /> --•--•-------- <br /> Alterations and/or recommendations:____________________"_________ -- . - <br /> ------------------- - •--..-..----------------------------------•-------••-----•----•-••--------•---------------------•------- <br /> ---------------------------------------------------------------------- <br /> - 4: <br /> -------------------------------------------------------------•------------------•-•------------------- -t----------------•--•----•----•-----•-----------•------------------------_.--.•---------••-----------._..._.---•-- <br /> L { <br /> _"____________________________________________________________________________________________________________________________________________________________________________________________________________________________ <br /> Y <br /> FINAL INSPECTION BY: . ----------- ------ 'Date----* "_ <br /> -------------------------------------------------------------------- <br /> �� <br /> SAN-JOAQUIN LOCAL HEALTH DISTRICT— <br /> ]30 South Amarican Street 300 Wert Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodir California Manteca,Callfornla Tracy,California <br /> EB-9 RE-BED 8-59 F.P.CO.2M 6.60 <br />