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/ FOR OFFICE USE: � <br /> ---------------------- <br /> -------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No.1,f?P2.� <br /> ` (Complete in Duplicate) <br /> ----------------- <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 Co(unnty Ordinance No. 549, <br /> JOB ADDRESS AND LOCATON c� � `�- _- _ N- --G6D, ------- - <br /> ------------------------------------------------------------------- <br /> j Owner's <br /> f Address__._ 10 ,� <br /> a <br /> -------- ----------------------------------------------•--------------------------------••------•----------------------------------------•-------------•------------------- <br /> ' Contractor's Name ti --- ----------------------------- Phone <br /> -- •-- ' a:-:-•------------- <br /> Installation will serve: Residence'g Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: A_____ Number of bedrooms o�-�___ Number of baths I_-__ Lot size ___- _____________-._____--_______________ <br /> Water Supply: Public$system ❑ Community system E] Private _Depth to Water Table AV- ft. <br /> I <br /> Character of soil fo a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> ! Previous Application Made: (If yes date________________ I No New Constructiom: .Yes �No E] FHA/VA: Yes E] No E]TYPE OF INSTALLATION AND SPECIFICATIONS: r <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet. <br /> Septic Tank: .;Distance from nearest well__00!A----Distance from foundation---- <br /> ..No. <br /> oundation__.-.No. of compartments------a---------------Size_,-4A_9S,a_________,__Liquid depthy_._____--_- _ -.Capacify___g� _. <br /> Disposal Field: Distance from nearest well_V0P(.k._Distance from foundation___-0)-'i--____Distance to nearest lot line.___-_____ <br /> Number of lines-------4------------------------Length of each line_a_(__ go250_'�Q_Width of trench__�____-_--,--------------------- <br /> Ty <br /> ------- <br /> } Tye of filter materiabte__j>r ---__-_-__Depth of filter material_1.a1-�-__j_.__._Total length_--._{_Ixjr----------------------------- <br /> pSeepage Pit: Distance to nearest well_____ ---------------Distance from foundation-------------------.Dista-rice to nearest lot pline_____--- _--___ <br /> ❑ <br /> p ----Lining material-----------------------Size: Diameter-----------__- --- ----Deth-----------------------Number of its------------------ -------• <br /> Cesspool: Distance from nearest well_______________Distance' from foundation_____-__ Lining material___.__._.--___---__________._-__.___. <br /> ❑ Size: Diameter--------------------- -----Depth-------------- ------------Liquid Capacity- --------------------------gals. <br />{ Privy: Distance from nearest well___________________ ----_- .Distance from nearest building____._.______._______,_ <br /> ----------- <br /> ❑ Distance to nearest lot line ------ ----------------------------------------------------------= ----------------------------------------------- <br /> I <br /> Remodelingand/or repairing {describe):- ---- ------------------------------------------------ ------------------------------------------------•------------------------- ------------- <br /> ;�-- - 4 <br /> --------------------------•-------------------;------------------------=------------------:------------------------------------------------------ --------------------{ <br /> _ F�4_�4� !______________________ _• ___________-_____._____-_________________-___.1-_?--__-____-____________-_- _-_____._.___---__-__-_ <br /> __-_ -__-___ ______________-_______. <br /> I hereby certify that I have prepared 11i�is application and that the work will.be done in accordance with San Joaquin County <br /> ordinances, S to laws, and rules and regula ions of the San Joaquin Local Health District. <br /> i r 1 <br /> (Signed) i I t-�-'----------------------------------°-------------- ------(Owner and/or Contractor) <br /> ---- - ---- -- - -- =-------- - - -------- <br /> Sy:-------- ----------- --I-----' --------------------------------------(Title)--------------------------- --- ------------------------- ------ <br /> (Plot plan, showing size of lot,llocation of system in relationito wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION <br /> PPLIICTION ACCEPTED,BY= €-- -------------------- -- -' <br /> - ---= -•---� - - - ------------- DATE----�=1- o-- -�.��---------------------------------- <br /> REVIEWED , <br /> BY----------------------'------------------- '�"------- - --r= J------------ ------------------------------- DATE------------- -- <br /> BUILDING PERMIT ISSUED--7--17-7-7--.7--_� ------ ----------------------------------------- DATE <br /> Alterations and/ot-recdmnlisndations:---- =w}'-=-'_=-- =- ==_ <br /> n. <br /> -------------__ ____._- - -____--___--___-_._-_.__.-_____---__-___-.____-________--___-.-_____-_________-_______-_-_-_._____---______-_-__.-_-_-______-_________---_ ___-_-___-___ � <br /> . -------------- �-- -- <br /> --------- , - -------------------------- <br /> FINAL INSPECTION BY:_._ -. ._ (�- {�b <br /> ' ----------------------------------- --- Date- <br /> - -- - --- - �----------- ------ - <br /> ------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,Californi;w'._ *:' Manteca,California <br /> , � Tracy,California <br /> F.P.CC. <br />