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FOR OFFICE USE: '� S <br /> ----- ------------------------- ----------- ----- ---- <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> ----- -------------------- <br /> --- (Comlete•in Dulicate) <br /> ---- - ----- -- pp <br /> _ _ �- . 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. <br /> JOB ADDRESS AND OCATION-,,o.��- V?4- -----C5 7-,,-.-- &fT A 5 _.._... "' �+ - �G -"�J <br /> e+ Ii <br /> Owner's Nam -- ------Fri ------- ----------------- ------ Phone---------------------- <br /> Address------------- ---- 090 13.a x---------- p ......... _N "/OG�.----..._ SL <br /> Contractor's Name--- .. - _ _..� ------- ------\. _Z.`.-------------------------- '- ----------- Phone------------ -•-------.-------- <br /> a <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ 'Motel ❑ Other ❑ <br /> Number of living units: __I----- Number of bedrooms -_Number of baths A----- Lot size --------- <br /> Water <br /> -__-.__Water Supply: Public system A Community system E] <br /> — <br /> Private❑, Depth7ft Water Table7$7- ft " <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ 1 Clay ❑ AdobeX Hardpan ❑ (N% <br /> Previous Application Made: {1f yes,date----------- ) No [ New Construction: Yes ❑ No NJ FHA/VA: Yes ❑ No "1 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.)► r <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation----------------'_..Material ___-------------------------------------..___._. <br /> ❑�>L��-f- No. of compartments---------- ------ Size-------------------- ----- -----Liquid depth--------- --- --------Capacity---------- •----------- <br /> Disposal Field: Distance from nearest wellAIQ.A2s"-- Distance from foundation__3Q_�'__._.Distance to nearest lot line- i 'v <br /> ----------- <br /> Number of lines -_ci< Length of each line-.. - Width of trench..._/!__________________ <br /> Type of filter materia!- .._Depth of filter material___!.- .__!__!..Total length__-�-Q-ir--------------- -------- <br /> Seepage Pit: Distance to nearest well-./ (>�(� ___Distance om f undation. --;JP-'-.-,.- Distance to nearest lot line_S�-_--- <br /> Number of pits-_-0-)_.........Liningfmaterial___ - Size: Diameter. i.........Depth--AS---L_______________ <br /> Cesspool: Distance from nearest well ------------I--- from foundation. ............... ..Lining material-------------------------------------. <br /> ❑ Size: Diameter- -- -------------- --------- --Depth-- -----------------------------------------------.Liquid Capacity- -------------------------gals. <br /> Privy: Distance from nearest well.............1-_--_--___._._..._.__.___.____._Distance from nearest buildifg---------.-..----------_-__.._.-_...___--- <br /> ❑ Distance to nearest lot line_�- --- --------------- -- _--'-`----------- <br /> --- - - - ---- ---------------- ------------------------------- - <br /> Remodeling and/or repairing (describe):- ► - - _"Q ( --A--�-�-x•---A--1�--------------- <br /> -------------------- <br /> -----------------------•---------------------------•---- -------------------- ----------------------- ---------------------------------------------------t----------- <br /> -----------------------`---------------------------------------------------------------------------------------•------------------------------------------------ <br /> - <br /> I i k J r ! <br /> -------------:.-------.-__-_- --------------- r--------------_-_---------------------------------------------------------------------_.----------------------------- <br /> I hereby certify that e?prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, ' nd r ea•ijnd-regulations:of-the San Joaquin Local Health District. <br /> (Signed)-------•----------------- -- 1 ......... CwAAJ ------------- -------------- (Owner and/or Contractor) <br /> 4 <br /> k By:------------------- e - (Title) <br /> (Plot plan, showing size of lot, location of system in re ation to wells, buildings, etc., can be place on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> y <br /> APPLICATION ACCEPTED BY-- z -—- -- ---�--- ----- ----------------- '� ` � 3~ g <br /> DATE-- -- -- - --- <br /> REVIEWEDBY------------------------------------ ------- ----------------------------*k- --------------------------------------- ------ DATE---------------------------------------------------------- <br /> BUILDING PERMIT ISSUED-------- -- ----------------------------------------- � - ------------- ---------- ----- DATE-------:------------------------------------ <br /> ---------------- <br /> Alterations and/or recommendations:....--.-- _- - -. � <br /> ------------------------------------------------------------------------------------ <br /> '4. <br /> FINAL INSPECTION BY:-------- ° , '-- --------------------------- # Date— -------------------- ........... ------------------------------------ <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 /> I E.H.9 2M 1-67 Vanguard Press <br />