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FOR OFFICE.USE: , <br /> ' APPLICATION FOR SANITATION PERMIT Permit No. c - -f <br /> (Complete•in Duplicate} <br /> ------ - -------- <br /> Date Issued <br /> ...... <br /> This Permit Expires 1 Year From 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 appI'c compliance with County,'Ordinance No. 54.9. �Q©A . <br /> MC4 V1 <br /> JOB AD ATION._BOW LUN'. <br /> Owner's Name.----- .0-d-------L ---01__ o�--- ---- �lLZ-f V ---------- ------- <br /> Address <br /> -----715_,50 Alz LUQ• - 1...12,yM__01 -------L ,f/ ------ <br /> Contractor's Phone._!_23-6,ST <br /> j Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> i Number of living units: __ ----- Number of bedrooms -------- Number of baths-------- Lot size -----AT/ _75;:�------------------- i. <br /> i <br /> Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table --Y- ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date................... I No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> ^t .. TYPExOF INSTALLA1ION4,ANDrSPECIFICATIONS: <br /> (No septic tank or cesspool permitted.if public sewer is available within 200 fee+.) <br /> Septic Tank: Distance from nearest well:...............Distance from foundation---------------------Material ______________-_.--_____._-._.___.____._-..._. n <br /> �l <br /> ❑ No. of compartments------- -----'---------- --Size---------:----------- -----------Liquid depth--------- -...... ........Capacity_------------------- <br /> Disposal <br /> ..-- -- •--- ----Disposal Field: Distance from nearest well.... Distance from foundation---.t0.____---.Distance to nearest lot line.___., -_._.. y� <br />} Number of lines.____.____-------._... _. Length of each line-- ___._: Width offrench._.___�__________________-_-._ <br /> Type of filter material.__../416i.__..._._Depth of filter material-----1.________Total length------ 7*___________________________ <br /> Seepage Pit."-;' Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line__.__.___.._-____ <br /> ❑ + z Number of pits.-- ---------- -------Lining material--------,----------- Size: Diameter------- - ----Depth---- -------------------------- <br /> Cesspool:,"' ` Distance from nearest well __._..._..____Distance from foundation___ _____-------- __Lining material------_------_----------------------- <br /> . <br /> Size: Diameter- -- --------- ----- ----- -.--.Depth.--. uid Capacity <br /> I ❑ p q - ------------ -------------gals. <br /> iPrivy:. Distance from nearest well _______________________...___ .................Distance from nearest buiiidip'l------------------------------------------- <br /> [] Distance to nearest lot line -------- -=--------------------------------•-•----------------•-------••------------------------------------- --------------------------- <br /> Remodeling and/or 'repairing (describe)------- --------- ---- ----------------------•-•----•-----•----------------•-------•----------•-------•-- -•-----------_--- -•-----------------. <br /> - =----------------------------------------------------------------------------- -------------------------------------- -------------------------- ------ -------------------- ------------------------------------- <br /> ` ----------•---------------------------------------------- - ----------------------------------------------•-------------------------------- <br /> ----------------------------------- ---------------------------------------------------------------- ----------------------t---=------------------------------------------------------------.----------- ----------- <br /> j I hereby certify that I have prepared this application and that +he.w:ork will be done in accordarice�'with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District.- ' <br /> (Signed:- ( +I ' (Owner,and/or_Contractor) <br /> ----------- <br /> BY ---{------ ' � ---------------- ----- --- Ti e <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 /> 3 APPLICATION ACCEPTED BY_______.-+. `_&_- - --- -------- ---­­---------- ------ DATE....& 1 <br /> -------- ----------------- <br /> REVIEWEDBY-- -- ------------- ----- - ----------- ------ DATE------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED-------- --------------------------------------------------------- ------ --------- -------------- - DATE----- -------------------- -------- ------------------------- <br /> Alterations and/or recommendations:_-- --------------------------------------------------- <br /> ----- <br /> .'---------------------------------------------- <br /> >. . <br /> --- ---------- ------------------------------------------- <br /> ---------------------------------------- <br /> ------------------•------._...---------- .............. ----------- --------- <br /> ----------- <br /> --- -- ......... ------- --- ------- - -- <br /> FINAL I PECT1 Date...,.;':j __/ j ------------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> I <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9Th Street <br /> w <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br />