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RF R�OFFICE USE: <br /> �.�. <br /> y — G� <br /> ----------- -------- ----} APPLICATION- FOR,SANITATION PERMIT : Permit No. .. <br /> :. (ComDate Issued plete in Duplicate) sE :r <br /> __.._-_ {this Permit Expires 1 Year from Date Issued <br /> -- _ na - <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descried. <br /> FThis application is made in compliance with County Ordinance No. 54�9­� <br /> f----------JOB ADDRESS AND LOCATION <br /> ,.P- <br /> hone--- <br /> -a----- --- <br /> - -- -- ! <br /> --------------------------------------------------------- -Owner's Name �------s <br /> ---------------------•--------...Address_____________ � ,r --- <br /> ---------- <br /> ----------------------- Phone--'y6..SE .X_*7Contractor's Name . <br /> � <br /> Installation will serve: Residence WQ- Apartment House ❑ Commercial p Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _1--- Number of bedrooms __4__ Num /____ Lot size ____ <br /> Number of baths _ .�..S�?C._---_- -474 ----------------- <br /> Water Supply: Public system R�- Community system ❑ Private ❑ Depth to Water Table Gi- ft. # <br /> z <br /> I Character of soil to a depth of 3 feet: =Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> I - Previous Application Made: (If yes,date__.__...__ No Rl--- New Construction: Yes ❑ No ®- FHA/VA: Yes ❑ 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 /> No. of compartments Size <br /> Liquid depth.............'------------Capacity------ ---------------- <br /> i �--.--Distance to nearest lot line <br /> �____. <br /> Disposa Field: Distance from nearest well.-M�'_____._Distance from foundation..____._.__-_ <br /> f` Number of lines------!---1-------------t-------Length of each line-------�------------------Width of trench-_---:�-------------------------- <br /> I Type of filter material___4 ?t------Depth of filters material___ ?.............. otal length__��____ _______________ _______ <br /> a__-_______Distance from foundation___I____-----____:Distance to nearest lof i ne___,f_�___-_. <br /> Seepage Pit: Distance to nearest well__-__� <br /> Number of pits------- ------------Lining material-----4_� __4-_Slze: Dia meter.-..7� Depth---- <br /> -.'----- - �:s__.._______..__.____. <br /> ` / <br /> Cesspool: Distance from nearest well____'___'__...__Distance from foundation....................Lining material____-_____._.._____.___.______-_. <br /> ❑ Size: Diameter------- -------- --.--------------Depth----•---------------------------------------------. Liquid Capacity----------------------------gals. <br /> Priv Distance from nearest well______.- -- ----- --- --------------------------Distance-fFom ne"aire'sf-'building..z-----------v------------ - <br /> Y' <br /> ❑ Distance of line:.__.___ =----- 'S <br /> -- <br /> Remodeling and/or repairing (describe)--------- -------------------------------- ---------------------- ----------------- ---------------- -... L� <br /> A - -----------------------------'---- -- ----------------------------------- ----•--------------- ----------------------------------------------------------- <br /> 3 <br /> yk <br /> ______________________ _________________ _-__-_._________________________7_______-_-_-_--___-________________________________._______________._.___-_-.____.___._____________-____.______.__.__ r` <br /> I 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 rules and regulations of the Joaquin Local Health District. <br /> (Signed) --- ----- -- ----- ----- �1 --- 'e---------------'---------- -----------------------------------------(Owner and/or Contractor) <br /> B - -.. . ------------'--------------------------------------------------------------------------(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 1[ � —------------------- ------ DATE-------- ------ . �� ` ^ <br /> REVIEWEDBY-------- --------------- ----- --------------------- ------------ -------------------------------------------------------- DATE--------------------:------------------------------------- <br /> BUILDING <br /> - <br /> BUILDIPERMITr ISSUED <br /> dations:----f-------- - <br /> --- --- - ` - ------------------------------------ DATE -------------------------------------------------------- <br /> ons n <br /> - <br /> ��. <br /> I <br /> , <br /> ' <br /> ----------------------------------'- --------------------------------------------- ------------------------------------------------------------------------- y <br /> i ' -------------------------------------------------- --------------------- <br /> ---------------------------'--- ---------- ------- <br /> i ------------------ -------- ------ ----I--------------------- <br /> - i <br /> FINAL INSPECTION BY:-.----- ------- Date-----�`�'.- iP_s----- --- -------- <br /> - ! SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1401-E.Flaxettan Ave.�- 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California._,ti Lodi,California Manteca,California Tracy, California <br /> F.P.CO. <br /> J< <br />