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FOR OFFICE USE: <br /> -- --- APPLICATION FOR SANITATION PERMIT Permit No. ........... <br /> --------------- -------- <br /> ! ----------------------- (Complete in Duplicate) Date Issued ..... -�O-... <br /> __ 'This Permit Expires 1 Year From Date Issued <br /> -- <br /> -- -- ----------- <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 /> i• - , <br /> � < <br /> i <br /> JOB ADDRESS AND LOCATION- �:. .' = -------�--� 1--------------- - <br /> 12.357 <br /> Owner's Name--------------_-_---�+I�--.--4��i �_Q_![\t 1�.-------------- ------ Phone 3. <br /> Address-------------------_--•------ ----------------------------------------------- <br /> --- <br /> ------------•-••-------------•---•-- Phone........ -------------------_---- <br /> Contractor's Name h -%-Lw .� <br /> Installation will serve: Residence JKf Apartment House O'""Commercial�❑ Trailer„Court ❑ Motel ❑ Other ❑ 6Ze,, . <br /> Number of living units:, -Number-of-bedrooms __z. Number of baths :-_ __Aoit.size.------------. _.___....... . ... ......................�;- <br /> F Water Supply: Public system El Community system,❑ Private I$( Depth to Water Table 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------------- ) Nog 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 /> I . <br /> Septic Tar Distance from nearest well_____-_.-___:__Distance from`foundation_____________ ___Material___.____-_--__-__________._________..__.___--_.. <br /> No, of compartments----------_---_-------_....Size----------------------------.___Liquid de th____.____-----------------Capacity <br /> Dispos, It F` Distance'from nearest Well__-S _r---.-_:Distance from.foundation.__�4.___...".Distance to nearest lot _._._.. <br /> Len th of each line_______ ,97_�_________.Width of french____2'_-_____ <br /> 'Number of lines__'_=-=.�=--- -�,: ----- � _. 9 --� {---------•----- <br /> 1 Type of filter materiah__1 -�� ___Depth of filter-material______ __-.______Total length______, ��______________________ <br /> f5 t _____Distance from foundation....................Distance to nearest lot line--------........ <br /> Seepage Pit: Distance to nearest'`well_._�_________ _� <br /> ❑ Number of pits-�------------------Lining:.material--------•- ---------- Size: Diameter-----------------------.Depth--------------------------------- <br /> Cesspool: Datance'from-nearest well-----------------Distance from foundation-----__%:_______.Lining material-,--_--._______-________._______-__.-. <br /> f <br /> D Size: Diameter------- { --Depth---------------------------•------------------------Liquid Capacity-------­------------------- <br /> Privy- "-Di tar`ce from nearest well _________--------_---------------------------'._Distance from nearest buildin <br /> ❑ Distance to nearest:lot line---------------------------------------------•-- ---------------------- ----------------•----------------------------------------•----------- <br /> Remodeling and/or repairing (describe}:-------------- ....� ------ _ ---�.. ---------------•-------------------------- <br /> { <br /> ---------------------------------------•-•------------•- --------------------•---------------------••------ <br /> r i <br /> ------------------------------------------------------=------------- -------------------------=------••----------------------•---------------------­--------•--•---••----------•-------•---------••---- <br /> ------------------------------------ -------------------=-----------------------------------------------------_----------------------------------------------------------------------------------- <br /> I <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 rules and regulations of the .San Joaquin Local Health District. <br /> (Signe G(/ - ----------------- ---- -------------- --------------------- -------------=------------------------------(Owner and/or Contractor) <br /> a <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----- --- -:c'- - - ------ --- --------------------------------------------- DATE <br /> --------- ---- <br /> ' REVIEWED BY---------------------------------- <br /> ----•---------------------------------------- DATE..-•-/ -�'J. - -- ------­--­- ------ <br /> --- <br /> BUILDING PERMIT ISSUED ----------=----------------------------.`-------------------------------•---•------------ DATE <br /> l Alterations and/or recorgmendations:'__ .= =----- ----- --- ------------------------------------------------------------------------------------------------------- <br /> -9 <br /> i -- --••- ------------------------------•--------------------- <br /> - •-- ----- ------- <br /> •---- - -------'-- C- -- -` <br /> - <br /> --- ----------------------------- <br /> --------------------------- ------------/ <br /> ------------------------ - r T'y` `L l ra''4. /f E r'Y=-=��✓moi c r�!..-_.-------------------------------------•-• ----------•- ---------------•----...----- <br /> FINAL INSPECTION BY:--- -------- Date----- --------------------------- ------•- ...- .._.........-..-....-•-------- <br /> SAN JOAQUIN LOCAL. HEALTH DISTRICT- <br /> _ <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,Callfornla Lodi,California Manteca,California Tracy,California <br /> E13-9 REVIrEG 6.910 r.P.CO.7M 6-610 /� - <br />