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FOR OFFICE USE: <br /> ---------------------------------------- `a r <br /> -_-__--____-__--_- <br /> -- ----------- ��/APPLICATION "R SANITATION PERMIT Permit No. .. 3.".�. .� <br /> -------------- ------------------------------- --------- J (Complete-in Duplicate) <br /> Date Issued ./V=d 73 <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 application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION- -�r�-'76 ( ..u_—g / < <br /> Owner's Name � ! -�'G� ------ <br /> Phone..................................... - ----------- ---- ----Cie ------------------------ <br /> Address--------- .a�__7 -- 't.. �-------- ------------------------------------------•----------------------------------------------------------------- <br /> Contractor's Name----- �,A_ �..__ ----------------------------------------------- <br /> ­ Phone.'1� .:r �..� <br /> Installation will serve: Residence Cff Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _- ----- Number of bedrooms _ Number of baths -I— Lot size -_---� _ , 14fz---------------------- <br /> Water Supply: Public system F] Community system ❑ Private 2f Depth to Water Table P- 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---------- -------- ) No W 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 Material -----.-__-------------_--.-_-.--..---......... <br /> 1771 No. of compartments-------------------------Size------------------------------Liqui _� - ------ ------- ------- <br /> Capacity----------_---------- "l <br /> Disposal Field: Distance from nearest well.),14f 1_Distance from foundation__.#,61e......Distance to nearest lot/�line.._0_f1"�t.. <br /> ❑ Number of lines.-._--__.f- .___..___.____-_Length of each line-- - of trench----a2Ta4.fc._.__.--_---- V <br /> Type of filter material__/�/n-Rae.KDepth of filter material -_-Total length -------------------------- <br /> Seepage Pit: Distance to nearest well-----_--------------Distance from foundation--------------------Distance to nearest lot line--------------_- <br /> 0 Number of pits---------------- Lining material--__--.-_.-_-_------ Size: Diameter___-.-------_---.---Depth...........-------------.___-___. <br /> Cesspool: Distance from nearest well ----------------Distance from foundation--- -----------.- -.Lining material...__-.--_----.-.-_--.--_--..----.. <br /> ❑ Size: Diameter- -- -------------- ----------------Depth-.----------------------------------------------Liquid Capacity-------_-------------_---gals. <br /> Privy: Distance from nearest well----------_.-.------------------'---------------Distance from nearest building---------.......---------_-------.-----._. <br /> ❑ Distance to nearest lot line------------------------- -------------------•--------------------------•-----------------------------•----------------------------------- <br /> Remodeling and/or repairing (describe): --------- <br /> ,-- --' <br /> -------------------------------------------------------- ---------- --------- ------------------ <br /> - <br /> ---------- ---------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------ <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 law , and rules and�regu.11ttjonsf the San Joaquin Local Health District. <br /> (Signed)------ ---caro. ---. -----------------------------------------------------------(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 /> /3REVAPPLICATION ACCEPTED BY_10 v ------------------- ----------------- ---- <br /> --------------- DATE------ <br /> --------------------------------------------- <br /> REVIEWED <br /> IEWED BY-------------------------------------------------------------- - ------ ------------- --.... DATE-------_------------------------------------------------- <br /> BUILDING PERMIT ISSUED---------- ------ DATE------------------ <br /> Alterations and/or recommendations:-------_------- ----------------- - - - <br /> ----- - --- ----------- <br /> ............. _:. r.�,------ ----- --------------ll P/?-= --------------------------------------------------------------------------- <br /> --------------- -------- --------------- -------- ----------- <br /> I--------------------- -------------------------------- <br /> �--------------------------------- ------- ------- --- -------------------------- <br /> FINAL INSPECTION BY:.-------------- ;C: -( a`Drte... ---- 7 <br /> - <br /> C <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> E.H.92M 1-67 Vanguard Press <br />