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-,--FOR OFFICE USE; <br /> 71 <br /> - -- ------- ------------- APPLICATION FOR SANITATION PERMIT Permit No. ..g./ !� <br /> ---------------- <br /> ----------- -------- ----- -------- (Complete in`Duplicate) lssuecl-_,?��_3 <br /> ----------- This Permit Expires I Year From Date Issued Date <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 County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION- -------/Y - ----- <br /> --------- ------ ------------------------------------ <br /> Owner's Name-- Af/ k�---------------------- Phone:4� ..- <br /> Address----------------------- - ------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> Contractor's Name--------- .3-774------------------------------------------------------------------------------------- Phone...•------ -------•---------- <br /> Installation will serve: Residence [Apartment House E] Commercial E] Trailer Court Ej MofelF] Other F] <br /> 4 <br /> Number of living units: ----.4._ Number of bedrooms 2----- Number of baths --- Lot size ------ --- 4F--------------------- <br /> `6 <br /> Water Supply: Public system Community system El Private E] Depth to Water Table -- ----- ft. <br /> P <br /> Character of soil to a depth of 3 feet: Sand [] Gravel [] Sandy Loam El Clay Loam E] Clay E] Adobe 2r"Thardpan I-] <br /> Previous Application Made.- (if yes,date----------------_--) No [!T . New Construction: Yes [D No [THA/VA: Yes El No <br /> f <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 7 <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Sept' Tank: IDisfance from nearest well--_-------------Distance from foundation_----.__-__----.-. Material-_.---..------.._ <br /> No. <br /> ateriai_--------------No. of compartments--------------------------Size -----------------•-----------Liquid depth---------- ----- - -- ----Capacity---------------------- <br /> Dispo <br /> apacity----------------------- <br /> DispoDistance from nearest well-—------------Distance from founclafloil.-Ya--.-_.-.Distance to nearest lot line----I.Ir------- <br /> Number of lines---I----------------------------- --Length of each line-----6--0-.'*-------------Width of trench.... Z-_7%-----------------­ _r <br /> Type of filter mate Depth of filter material----/___.. ........Total length........40---------------------------- vV <br /> Seepage Pit: Distance to nearest well-(------------------Distance from founclafion-10------------.Dislance to nearest lot line-.5.........X <br /> Number o� pits-----1------- -------Lining rnaterA?C)_(,-,<.__.1.SiZe: Diarnefer.-n�_;!-.11-1---- Depth--- ------------ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------- ---- ---------------------- <br /> E-I Size: Diameter--------------------- ----------------Depth------- ------ ------------------ - ----------------Liquid Capacity---------------------------gals. <br /> Privy: Distance from nearest well------------------------------------ ------_----Distance from nearest building.-- -- ----------------------------------- <br /> f F-I Distance to nearest lot line- ---------------------------------------------------------------------------------------r---------------- <br /> Remodelingand/or repairing (describe)------ ----------------------------- - -------------------------------------------------------•-------------------------------------------------------- <br /> - <br /> ------------------------------------------------------------------ ----------- ----------- -------------I--------------------------------------------------- -------------------------------------------------- - <br /> ------------------------------------------------------------ ---------------------------------------------------------*------------------------------------------------------------------------------- <br /> -----------------------------------------------------------------------------------------------------:---------------- ------------------------------------------------------------------------------------------------------ <br /> I hereby certify that I have prepared this application and that the work will 6e done in accordance with San Joaquin County <br /> ordinances, State laws;andrul an�d :re ulations of itile San Ji .aquin Local'Health District. <br /> (Signed)-------------------------- -- ----- -------- --------=:7t - ---------------------------------------------------- --------------------(Owner and/or Contractor) <br /> By:--------------------------------- ---------------------- ---------------------------------------------(Title)--------------------------------------- ------------- - <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY- -----00 <br /> ---------­. -------------------------------- DATE--- 19-1---------- --------------------- <br /> REVIEWEDBY------- ------------------------------------ -------------------- --------------------------------- . DATE------ --------------------------------------- <br /> BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- <br /> Alterations and/or recommendations---------------------------------------'---- -------------------------------------------------------------------------------------------------- ----------------- <br /> ----------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------I--------- I------- --------------------------------- - - --------------------------------------------------- --------------------- -----------1-1-­----------------­----------------------------------- <br /> ----------------I------------------------------------------ ------------------------------------------------------------------------- ----------­ ---------------------------------_----- - ------------------------ <br /> -- --- - - ---------­.­........... -------------------I---------------------- ---------- -------------- - - ---------- - ----------- --------- --- -------------------------------------------------- <br /> ----- - - - ------ -------------------------- <br /> FINAL INSPECTION - --<-. -------- -----­------------- Date........ - <br /> P <br /> S N JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 3 West Oak Street 124 Sycamore Street 205 West 9th Strew <br /> Lodi, <br /> CaliforniaStockton,Calffornia Lodi,CaliforManteca,California Tracy,California <br />