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FOR1WCE USE: <br /> ------------ <br /> ------------------- APPLICATION. FOR SANITATION PERMIT Permit <br /> -------------- ------------------------- N-------- - r (Complete in Duplicate) Date Issued <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 /> JOB ADDRESS AND'LOCATION-------7-------74j <br /> - " <br /> -- ------ ----- - - --- -- ----- ------------------------------------------------------------------------------------------- <br /> -------- Phone--------------------- <br /> Owner's Name---d- --------- ...... -------- <br /> Address------ <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> Contractor's N ­------------------ ..................... <br /> f ------------------------------------------------------------------------------------------ Phone................................... <br /> Installation will serve: Residence El"-Apartment House E] Commercial E] Trailer Court Ej Motel F] Other [I <br /> Number of living units: ----t--- Number of bedrooms -477 Number of baths 2.-- Lot size -z5—_X--Lf P______________________________ <br /> Water <br /> ------------------------------ <br /> Water Supply: Public system El Community system F] private t1--lDepth to Water Table <br /> Character of soil to a depth of 3 feet: Sand E] Gravel [-] Sandy Loam E] Clay Loam E] Clay E] Adobe [4--<ardpan C1 <br /> Previous Application Made: (If yes,date--------------------) No &_�ew Construction: Yes 2q-<, [3 FHA/VA: Yes *-"'-No 2--- <br /> r <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ?4 <br /> Septic Tpk: Distance from nearest we1I___,5A__`__Distance from foundation--- -------.Material----- --CAe-,- <br /> .je-------------- <br /> Ir No. of compartments----,;2------------------SizeP��_-_'(V-/V�Liquid clepth----------v,-__*--____-__Ca <br /> 0 - 7._.._... <br /> 7 --- <br /> Disposal Field: Distance from nearest well__�$ ------_Distance from foundation--- --------Distance to nearest lot line---6-7........ <br /> Number of lines__J5----------------------------Length of each line------------------------------Width of trench—Z-4--- ------------------- <br /> Type of filter materiaF ----Depth of filter maferiaI___,/_�__,----------Total length_-__--_IZ-115%t-11-----/,�*" <br /> Seepaq,p-Pit: Distance to nearest well_h1*_;10­,_.---Distance from foundation---1A ......Distanc e to nearest lot Ii ne----\Y_ _j <br /> ............. <br /> ET Number of pits--_3____________Lining mate ria Lr 7ffo_tA----Size: Diameter____._ ___ _�Depth---- -:Z-37- <br /> 3, ;- , <br /> Cesspool: Distance from nearest well ------------------Lining well________________Distance from foundation_____________ material_______-___._______-__-_________. <br /> ❑ <br /> aterial-------------- ---------------------- <br /> El Size: Diameter------ ------------------ -------Depth----------------------------- ----------------------Liquid Capacity-------- -------------------gals. <br /> Privy: Distance from nearest well--------------- -----------------------------Distance from nearest building____________________-_________-____. <br /> ❑ <br /> uilding------------------------------------------ <br /> 0 Distance to nearest lot line-------- ------------------------ --------------------------------------------- --------------------- ---------------------- <br /> P_ <br /> Remodeling and/or repairing (describe):----------------------------------------------------------------------------------------------------•------------------------•---------•--•-------..... �f, <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------- --------- ------ <br /> -----­­--------------------------- ----••--•-------------------------------------------------------------- ----------------------------------------------------------------------------------------------------I--------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------•------------------------------------------------ <br /> I <br /> -----------------------------­------------------------------ <br /> 1 hereby certify that I have prepared this a Incation and tho the work will be done in accordance with San Joaquin County <br /> T I T <br /> d reg 1, <br /> ordinances, State laws, an I n, regulaf. s e San Jo uin Local Health District. <br /> (Signed)----------------- <br /> ............. <br /> --- ------------------------- ­---------------------------------------------------------------------------------- ----(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 /> APPLICATION ACCEPTED BY---------------------- -- - - - -- - ---------------------------------- DATE-----------5.r --------------------- <br /> REVIEWEDBY------------------------------ --------------------------- --------------------------------------------- DATE------------------------------------------------------------ <br /> -------------------------- ---------------------------------- <br /> BUILDING PERMIT ISSUED--------------------------- DATE <br /> - ---;4X <br /> Alterations and/or recommendations:------------- <br /> ------------------------------------------------------------- --------------------------------- <br /> ------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------_-------­1---------------------------------------------------------­­----------------------------------------------------------------------------------------- ---------------------------------- <br /> ------------­--------------------------------------------------­----------- ---------------------------------------------- ----------------------------------------------------- ------............ <br /> --------------- ------- -------------------- ------------------ -----­-------- -------------- --------------------------------- ----------------------------------------------- --------------- ------ <br /> FINAL INSPECTION Date_---------- <br /> ---------------------------- ------- ---------------------------------------------------------------- <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 />