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FOR OFFICE USE: <br /> --------------------------------------- --------- ----- If <br /> __.__-__._._.._-_ -----------------_------------------ APPLICATION FOR SANITATION PERMIT Permit No. ..11 ��.. <br /> -------- ---------------------------------- (Complete in­Duplicate) Date Issued <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. CARDOZ f_AmW GR00 P . A TC.A <br /> L t <br /> JOB ADDRESS AND LOCATIO __'F____50------ ___ <br /> Owner's Name `v RJ r._ N_r�----`' -- -- ---- Phone. <br /> Address...... -----h.AN_DOR.F---------- -t_ `�-_--�aA....N ...--- . QAI 4AND.._. ------ <br /> Contractor's Name-----119 mF-K---------------------------------------•-•---------------------------------------- ------------- ------------------ Phone................................... <br /> Installation will serve: Residence E] Apartment House E] Commercial E] Trailer Court ❑ Motel E] Other [ X87NWD <br /> Number of living units: -1----- Number of bedrooms __I____ Number of baths --- ___ Lot size --- s Fz---.---f--------------- <br /> Water Supply: Public system E] Community system Private ❑ Depth to Water Table Ps-- 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 Er New Construction: Yes 2o"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 /> Sep[tic ank: Distance from nearest well_160___ Distance from foundation__.- ------.Matefi I__ <br /> _--.-___-- <br /> No. of compartments_---_� --_---______Size-_ Liquid de th--.-_��� ---= Capacity---- <br /> Disposal <br /> a acitY___-Disposal Field: Distance from nearest well_/t'P----._Distance from foundation/'�------------Distance to nearest lot line.._.''_-__ .... <br /> Number of lines----.----/_ -----------------Length of each line---------90-_ .ter____._.Width of trench._-.-AY---�./---------- ---- <br /> Type of filter material--8 4 K------Depth of filter material-----/_�-_.*_-_._Total length_____________________:J_Y----------- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line--._-----_..___- <br /> ❑ Number of pits---.-------------- Lining material----------------------- Diameter------------.----------Depth_.----__----_---___--_--_-_---. <br /> Cesspool: Distance from nearest well-----------------Distance from foundation__-_____-_.___Lining material_-______-.._--------------_._____-_. <br /> ,t ❑ Size: Diameter- --- ------------------------------Depth--.------------------------------------------------Liquid Capacity--.------------------------gals. <br /> Privy: Distance from nearest well----_--------------------------------.-----------Distance from nearest building----------.-------------------.-_.---._-. <br /> ❑ Distance to nearest lot line --------------------------------- --------------------------------------------•------------------------------------------------- <br /> Remodelingand/or repairing (describe):------------------------------------------------------------------------------------------------------------------------------------- -------- <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 laws, and rules and regylations of the San Joaquin Local Health District. <br /> _(Signed)-" - le! � -----(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 DEPARTM T USE ONLY <br /> APPLICATION ACCEPTED BY R,------'----------------------------------------------------- DATE •�!' _'. - -------- <br /> REVIEWEDBY--------------------------------------------- ---------------------------------------------- --------------- ----_ DATE------ ----------------------------------------------------- <br /> BUILDINGPERMIT ISSUED-------------------------------------------------------------____------------------------------... DATE------ •----------------------------------------------------- <br /> Alterations and/or recommendations--------------------------------------- -------- -------------------------•----------------------------------------------------•---------------•- ----------- <br /> -----•----------------------------------------•-------- -- - --- - ---- ----- - --------------// -- -- <br /> -- --•------------------- ---------------•------------------ -•------ <br /> ------ <br /> FINAL I Date------ ------ <br /> SAN <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 <br /> Tracy,California. <br />