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FOR OFFICE USE: n D <br /> ---------------------- ____ ------ APPLICATION FOR SANITATION PERMIT Permit No. .a`-f. <br /> -------------------------------------------------------- (Complete in Duplicate) 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 c nstru tp nd in all the Norherein described. <br /> This application is made in compliance with County Ordinance No. 5R. ! Iii (r 0%, R,e� <br /> n 4 ` <br /> JOB ADDRESS AND LO ATION.�1_9040_.__cs;af .. _ �.___.... <br /> Owner's Name -----------r <br /> -- ------------- Phone_s.. s�- --t3,? <br /> Address----------------------- �--- ---------- ------------------------------•-•-----•--- <br /> �•�-- -------- - - --- <br /> Phone­.,6.6:Z^./ <br /> Contractor's Name �-,�'L►� ------ --=-Ft--- t T�uCt'+� � <br /> Installation will serve: Residence �( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -1------ Number of bedrooms___ Number of baths j-__ Lot size __/_ .2R.....--___________________________ <br /> Water Supply: Public system E] Community system F] Private p—l�epth to Water Table - ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam lay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No ❑ 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 /> Se Ta k• � Distance from nearest well--______-_.___Distance from foundation--------------------Material------------------.-_--________________--_____. O <br /> No. of compartments--------------------------Size----------------------------:_..Liquid dept------------ ------------Capacity----------------------- <br /> O <br /> D• sal •e • istance from nearest well-"do..? Distance from foundation _______-Distance to nearest lot line----.-6 <br /> Number of lines________ ______________ _ ___Length of each line�j,-.'�____________-..Width of trench.-4/!—_____. <br /> ,,�, T e of filter material �i <br /> yp �"�myaZtx '_-Depth of filter material---�_��-------------Total length-----------��--�--�__--- <br /> Seepage Pit: Distance to nearest well_.�_______________ ____Distance from foundation--------------------Distance to nearest lot line----------------- <br /> El Number of pits.-..--.---------------Lining material----------------------- Diameter------------____-------Depth--------------_-------._,_-__-__. <br /> Cesspool: Distance from nearest well--------------.__Distance from foundation--------------------Lining material____-.__--__________________________ ~ <br /> Size: Diameter--------------------------------- ----De th------------------------------------- ----------Liquid Capacity ----gals. <br /> Privy: Distance from nearest well---------------------.---------------------------Distance from nearest building______-____-_________-___--__-..._-_-.. <br /> ❑ Distance to nearest lot line----------------------------- --------------- ----------------------- ---------------------- -------------------------------------------- <br /> '` f <br /> Remodeling and/or repairing (describe)_________ __ ___ <br /> --------------------------------- ----------------------------------------- _ _ �: . :�/r ____:_::_ _ <br /> ----------------------------- ------------------------------------------------------------- - -----------------•-----------•----------- --- -----------------------------•----•----- ------------------------- <br /> - - -- -- ----- -------- <br /> I hereby certify that I have prepared this application and that the work will bZ:7 ce with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Hea h <br /> (Signed) ^^ (Ct1Ar � Contractor) <br /> �C - <br /> BY:--------------------------------------------------------------------------------------- ----- ---------- ---------- ----- (Title)------------------------ ----------- -- -- ----- ---- <br /> (Plot plan, showing size of lot, location of system in relation o wells, buildings tc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---------------I'___I .O---^---------------------- ------------------------- DATE-------- - -1 - ---------------- <br /> REVIEWEDBY------------------------------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------ ------.-.--------------- ------------- -------- <br /> Alterations and/or recommendations:---------- ------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------------------- ------------------------------'----------------------------------------------------------- -------------------------------------------- <br /> --------------------------------------------------------- --- --- <br /> -- - ----------- <br /> FINAL INSPECTION BY - Date-------------- .--h---46 ------►-------------------- •------- <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 /> F.P.CC. <br />