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FOR OFFICE USE: 44 <br /> --------------------------------------------------------- <br /> - <br /> APPLICATION FOR SANITATION PERMIT Permit No. ... ... <br /> - ------------------------ ----------------------------- (Complete in Duplicate) �— <br /> This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Loca! Health District 4or a permit to construct and install the work hereindescribed. <br /> Al <br /> This application is-�ade in compliance with County Ordinance No. 549. /r 11-CA <br /> JOB ADDRESS AND <br /> LOCATION y---/2o--r `3i0 ---- - .QF_.....J4CKMC- <br /> Owner's Name / �lC.t ---° P <br /> Address <br /> Address-----•-----�------ <br /> w! f�� T� F I I <br /> ---------------------------------------------------------------- <br /> i . <br /> Contractor`s Name----C!gRG1f_L_7 --------------- - --- ---I-------------------------------•--------------- Phone---------------------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial IEJ Trailer Court E] Motel ❑ Other E]3 # , r <br /> Number of living units: .----- Number of b.edrooms.•3___ Number oflbaths /---- Lot size --------------------- <br /> Water Supply: Public system ElCommunity system ElPrivate 8;bepth to Water Table/ ft. <br /> Character of soil to a depth of 3 feet: Sand 1.m Gravel ❑ Sandy LoaL-] ClayLoam [] Clay E] Adobe ❑ Hardpan E] <br /> Previous Application Made: (If yes,date----------y_ ......1 No Z?�--New Construction: Yes �lo ❑ FHA/VA: Yes ❑ No ETJ <br /> TYPE OF INSTALLATION 'AND SPECIFICATIONS: r <br /> (No septic tank or cesspool permitted if,public sewer is available'within 200 feet.) �3 <br /> % ::� �-i It <br /> Septic Tank: Distance from nearest well________________Distance from foundation___ _=Material_____... __-__ -----.----_-_----..-.-.---.--. <br /> �7 N No. of compartments----------- k-----------S � ------J --Liquid deP h--------- f>-(Ca placity------------------- <br /> Disposal Field: Distance from ,nearest wellf.5 - fe,6 siance from foundation to nearest lot line---__ '� <br /> ,fir ;v _x �--------.�+ <br /> FJC�T/ /JG Number of fines------- --- ---=a,- ------- -Length of each line-- -- -- a-----.Width of french-- �`_--e-------•-- <br /> ,P� A 1 Type of filter €aterial 3 CK Depth of filter material__- ......Total length---------------- ----_---__----.-- <br /> - 4� <br /> M' Seepage Pit: Distance to nearest well_______________ ____Distance from foundation--------------------Distance to nearest lot line----------------- <br /> El Number of pits----------------------Lining material-----------------------Size: Diameter--------------.--------Depth----.-------.-------------.----- <br /> Cesspool: Distarice-frop'nearest well__-----__-__.-_Distance from foundation--------------------Lining material---------- ` <br /> ❑ Size: Diameter- -- ------------------ Depth_---------------------------------------------------Liquid Capacity----------------------------gals. <br /> `, <br /> Privy: Distance from nearest well--.----------------------------------------------Distance fromnearest building------------------------------------------ <br /> (" r <br /> ❑ Distance fo nearest lot line------------------------------------------------------------------------•--;-------------------------------------------- -------------------- <br /> Remodeling and/or repairing Idesc ibe):�-"_-r __..__._ <br /> --€"---_ " ------------- <br /> i _. til . .- , # ! e <br /> ix -----•• ----------- ------------------------------------------------- -41 <br /> -------------------­­---------- fi------------------------------------ ---------------•----------------------------------------------•------- <br /> ----------------_0 <br /> - ----- -------------- ------------------------------- <br /> e <br /> I hereby certify that I have prepared this application and that the work will be donin accordance with San Joaquin County <br /> ordinances, S a la ' an ules and regul ;ions of the San Joaquin Local Health District. ��1 <br /> (Signed)----- --- -r-(�•/-•�� a--- ------------- ---------- - ------------ - ------------------------------------------(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). t3 <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------- --------------------------- -- ---------------------------------------- DATE------ 2 -1D 6 -------- <br /> REVIEWEDBY------------------------ - -- -----------• DATE----------------------------------------------------------- <br /> BUILDING PERMIT ISSUED---------------------------------------------------------------------------- ----------------------- DATE------ -------------------- --------- ----- ----------------- <br /> Alterations and/or recommendations:------------------..----------------------------------------------------------------------------------------------- ------------- ---------------------------- <br /> --------------------------------------- ---- ------------------------------------------------------------------------------- ----------------------------------------------------------------- ---------------------------- <br /> -----•-------------•------•---------- -------•----------•------ ----------------- ------ <br /> FINAL INSPECTI5 y 2----- -- J S�I�` , <br /> Date--- - - ------ --------------------------- <br /> SAN <br /> ------ - -----------SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazellon Ave, 340 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> • r.P.0 O. C" `7 <br /> 7 <br />