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FOR OFFICE USE: <br /> ----------------------------- --------------- <br /> ----------- ------ _ "L ---------- FORS-.SANITATIONAPPLICATION, FO -SANITATION PERMIT Permit No. <br /> ------- ,.�L—_ <br />-- ------------------------------------------ -- --------- (Complete in Duplicate) <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 LOCATION____________________________________ <br /> --------------------------------------------------------------------------------- ---------------------------------I----------- <br /> Owner's Name..... ------ ---e----------Y,�1 . 6 <br /> - ------------------------------------ Phone--/ 0 <br /> ---------------------------7 <br /> Address.... ------- ------- ...... -------------------------------------------------------- ---------------------------------------------- <br /> ----------- Phone... <br /> Contractor's Name----- ----- ------------- <br /> _2 <br /> Installation will serve: Residence [Apartment House [I Commercial E] Trailer Court [] Motel Ej Other ❑ <br /> Number of living units: ___I_ Number of bedrooms --/-- Number of baths ___/-_ Lot*si,b --- ----------- <br /> Water Supply: Public system 0 Community system E] Private M----Depth to Water Table 3719 ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel Sandy Loam E] Clay Loam El Clay 11 Adobe [Hardpan 0 <br /> Previous Application Made: (If y—es', No New Construction: ,Yes E] NoP1 FHA/VA: Yes 0 No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permiffed.if public sewer is available within 200 feet.) <br /> �4ticLTn k Distance from nearest well-----------------Distance from foundation!,—------------ Material------------------------------------------------- <br /> No. of compartments--------------------------Siz�7------------------------- ---Liquid depjh--------------------------Capacity----------------------- <br /> r <br /> u1sposal Field: Distance from nearest well.,n ........D+stance from fcunclafion0 <br /> _/- -----------*-Distance'to nearest lot line__5__---e� <br /> Number of Iiies------/------ -------Length .#o.f.each;line---- - ---------- --- Wjd1h of french.....j�� --------------------- <br /> I : //------- -1----3-a- I <br /> Type of filter materia____ _r - ----6 material__ ___________.Total length___.:___. --------------- ----- <br /> I P Depth of filter aferial_�__ --- <br /> Seepag if: Disiancelto nearest well./,O.O-----------Distance from foundation-t,2-�__/.---.Disfance to nearest lot line_-,5_"_.------ <br /> Numberof pits- -------Uriing material""51 <br /> _7rO +------Size: Diameter----33- -- <br /> - ---------Depth-----_.... <br /> . ..5------------------- <br /> : <br /> Cesspool: Distance from nearest well------------------Distance from foundation._..__.............Lining material__..____.-..______.__..__________.._ <br /> El Size: Diameter----I--------------- -- - ----------Denf h-------------- CapacitY------------:---------------gals. <br /> Privy: Distance from nearest well---------------------------- ---__________________Distance from nearest bui;cling---------------------------------------- - <br /> 0 Distance to nearest lot line---------- ---------------- ---------------------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe}:---------------------- ---------- ---------------------------------------------------------------------------------------- ---------------------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------­------------ <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------I----------------- ---------- <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, ate la s, and rul and -"gulafions of the San oaquin Local Health District.. <br /> (Signed) <br /> ---- --- --- -- ------------------------------- ---- (Owner and/or Contractor) <br /> By - <br /> L� f ------------------------------------------ ---- ----------------------- <br /> -_-------------- --- <br /> --- ----------------- <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 /> --------------------------------------------- DATE...... - -------------------------------- <br /> APPLICATION ACCEPTED �- ----=�� <br /> REVIEWEDBY-------- ------------------------------------t---------------I------------------I--------------------------------------- DATE------------------------ ---------------------------------- <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------- ---------I-------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:-----------------------------------­­-- ------ -----------------------------------------------------------------------------------------:-------------- <br /> ------------------------------------- ------- -------------- -------------- ---------I-------------------------------------------------------:-------------------------------------------------------------------------------- <br /> ---------- ----------------------------------------------------------------------------------__----------------------------------------------------------------------------------------------------------------------------- <br /> -------- -- -- -- ----------------------------------------------- - ------ ------------------ -----------------------------------------------------------I----------------- - -----­_­­ ------------ <br /> ---------------------------------------------- <br /> --------------------------------------- - ------ - - ------A- ----------------------------------------------------------------------Date-------------------------------- ? <br /> --- ------- <br /> FINAL INSPECTION BY-------------- ..i-------9" -------- . <br /> SAN JOAQUIN LOCAL-HEALTH DISTRICT <br /> Illy' <br /> 1601 E.Hazollon Ave. .300 West Oak Street X 124 Sycamore Street'j 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California- Tracy,California <br />