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FOR OFFICE USE: - <br /> - -� = ------ -- -------1 / <br /> �.� 1 APPLICATION FOR SANITATION PERMIT Permit No. F �.. - ) <br /> -------------------- <br /> ----------- i- -- -----+-- .--------- {Complete in Duplicate) s g� S <br /> - - ------- <br /> ........ ..... !__t3 -_-- This Permit Expires 1 Year From Date Issued <br /> Date Issued _ <br /> Application is hereby made to the San Joaquin Local Heal h Distri t for a permit to construct and install the work herein described. <br /> This application is made in m is ce wit o nt r c <br /> ADDRESS AND LOCATION- _-_7-1 <br /> JOB s ' <br /> Owner's Name------ -•------- ----- --------------- ---- ----------------- ------------ ------------------------- Phone----------------------------------- <br /> Address / y7-_'-: . <br /> r <br /> Contractor s Name - -- A*-rd---` -------- --- --- -----------------------•- <br /> I-------------------. Phone----------------------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __ Number of bedrooms -Number of baths _3_ Lot size _' _____ _____________________________--- <br /> Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table &21574 , <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan [j V, <br /> Previous Application Made: (If yes,date_.----------....... ) No Ra'-_New Construction: Yes Zi—No ❑ FHA/VA: Yes g;_�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 ___._..Materia ____-________._.. <br /> No. of compartments___:*.._ _Size ? _ X' iquid depth___�4-----.- ------- Capacity"Z. ��_-. <br /> I Disposal Field: Distance from nearest well_--_` -------Distance from foundation-_ _/ <br /> ,rAO------- Distance to nearest lot line__4—...._ <br /> i <br /> mss' Number of lines -------'�___ Length of each line/949---------------Width of trench_ -____..----....--___-...__--._ <br /> Type of filter materiaV�%_-.-- �Depth of filter material__ __----Total length.-.�✓_ -------------------------- <br /> Seepage Pit: Distance.to nearest well................ .Distance from foundation---------_--------- Distance tonearest lot line----------------- <br /> El Number of pits-_. ------------------ Lining material---------------------- Size: Diameter----•-------------.....Depth--------------------------------- <br /> i' Cesspool: Distance from nears t well --- ------------Distance from foundation-----....- ---- Lining material------------------------------------- <br /> nSize: Diameter- -- - --- -------- ----------------Depth---.----------------------------------- - Liquid Capacity-------------- --------gals. <br /> Privy: Distance froffi -nearest well---------------------------__- ----..-..-.-.Distance from nearest building------------------------------_.-..-_-_--- <br /> ❑r Distance to nearest lot line ................. <br /> , -;;. ------------ - - <br /> Remodeling and/or repairing;(describe) 1'� - ��-- /-- ------------------ ------ <br /> k.. <br /> -• ----------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------.------------------------------__---.._-_--_---..-_------_-._---_--_-_-_________------_--___.-----.--.--.---____._-.----_..._---.--.._-_---.--_-..--.-_----._.-.--._-_---------- <br /> ---------- <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 rulestand regulations of the San Joaquin Local Health District. <br />' ------ --- --------------------------- <br /> i (Signed) --�/ �--- �r Contractor) <br /> Plot tan, showiri Lsize o-- lot, ---- on of s------ in rela (Title)___ ................................. <br /> Y <br /> ( p g y tion to wells, buildings, etc., can be placed on reverse side). <br /> I } FOR DEPARTMENT USE ONLY <br /> I APPLICATION ACCEPTED BY- ---- ---------------:.- DATE - ` Y <br /> REVIEWED BY----------`-------------- - -- ----- - -- DATE <br /> ------------- <br /> BUILDING PERMIT ISSUED ----- _. - DATE <br /> - ` --------- <br /> Alterations and/or recommendations--------- ------- --------- <br /> f <br /> } - ------------------- -------------------------------------- ------------------•--- -- -------------------------- --------- <br /> - ------------------- ------ ......................................... <br /> r a 3 <br /> i ..-----------..."...-.----------.-------.-_----._..... ----__----------.-. --------------------- .-._--------.-------.------------------------------...___-._....---------..----------......----.----------------- <br /> FINAL INSPECTION BY: Ll+rw ­� . ----- ----- Date..... ----- <br /> 4 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICTm <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,Collfornia Lodi, California Manteca,California Tracy, California <br /> E.H.9 2M 1-67 Vanguard Press <br />