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FOR OFFICE SE: <br /> °`� 3/--�3 �-- 81, <br /> Permit No. S� <br /> 7 <br /> APPLICATION FdR SANITATION PERMIT <br /> - ________ ______________ (Complete in Duplicate) Date Issued�r/_6 <br /> - This Permit Expires I 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 compliancelwith County Ordinance No. S44. <br /> ._'S �`T' ------------- <br /> JOB ADDRESS AND LOCATION..__ -© -- ., / <br /> Owners Name. --- --------- -•----• - A <br /> (/ ------------------------------ <br /> -- <br /> Address------------- ---------------­-------------- -------------- --------------------------------------- _.} <br /> Contractor's Name------ - i"�---- <br /> '{ Phone-------•--•---------------••------- <br /> -------•--- ot <br /> E] A eh„❑ Other ❑ <br /> Installation will serve: Residence Apartment House ❑ Commercial Trailer Courf"❑ MJ_ <br /> _ Lot size- <br /> f_Q_Q------------------ ----------- <br /> _. <br /> . Number of living units: -------- Number of bedrooms -3-- Number of baths __ ___- , <br /> k <br /> Water Supply: Public system Community system F­1Private ❑ Depth to Water Table -------- t Hardpan <br /> 1 <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam El Clay Loam El Clay E] Adobe❑ <br /> Previous Application Made: {If yes date__..___.- ) No [3 New Construction: Yes E] No E] FHA/VA: Yes ❑ No ❑ <br /> L # <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septip Tates k Distance from nearest well-----------------Distance from foundation-------------------Materia4------------------------------------------------- <br /> --------- <br /> --------- ----------------------------------- <br /> No. of compartmehts. Size. ---------Liquid epth--------------- -- -------Capacity-- --- <br /> �J Distance from foundation_______.__.____.Distance to nearest lot}ine___ �_____. <br /> Dispos I Field Distance from nearest well.. `t�------ line____-_ S`�_ -____________.Widthfof trench__._')---------------------- <br /> Number <br /> _._,_____ _ <br /> t <br /> Number of lines---------- ------------------------length of ea�h „ � ' <br /> 0 1 <br /> Type of filter material-__�Q_C-1(_`_.__-Depth of filter material_.----[_�1_---------Total/length______.-ffv-- --------------- ---- - <br /> cj <br /> Seepage Pit: Distance to nearest well____.'_______._ __Distance from foundation---a L--_fes-.Distance to nearest ;of line_________________ <br /> Linin material-- <br /> , s?.C_l _._Size:..Diame'ter ------ ------- --- Depth....61.X-fix_�' ! <br /> �&A�T. Number of pifs-------------- -- g Y <br /> #'*— - N. <br /> Cesspool: Distance from nearest well___-_.-______:__Distance from founda+ion-----------------_L ning Cat act gals O <br /> ❑ Size: Diameter-1--1-------•-------- ------ ---------Depth--------------------- ----- LiquidCapacity <br /> Privy: <br /> Distance f�fom nearest w0-------------------------- ----------------------Distance from nearest building----------------------------------------- <br /> { <br /> .. <br />'l ❑ Distance tonea resline- <br /> ` t lo+ --------------- ___-•-__."- <br /> ------------------------------------------------------•------------------ <br /> describRemodeling and/or re alrin g ------------- - ------------- <br /> I hereby__.certif__that I havepreparedl <br /> --------------------- <br /> --------------•------------------------------------------------- ; <br /> this appkication and that the work will be done in�accordance with San Joaquin County <br /> ordinances. State laws, and rules and�regul6tions of the San Joaquin Local Health District. <br /> __(Owner and/or Contractor) <br /> (Signed / <br /> ------------ --- --------- ---------- ------ ------ - ----------- <br /> Title <br /> i (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__: --•------ <br /> ------------------------------------ DATE-- ----------------------- ---------------------- <br /> --- ------------ ------------ DATE--------- ------------------ ------------•--------- ----- <br /> REVIEWED BY-------------------------------------------- --------- -- - DATE <br /> ------------- <br /> BUILDING PERMIT ISSUED-------------`-------------------------------- ----------------------------------- <br /> ., ------ <br /> Alterations and/or recommendations----1------- -- --------M--------- ----------- -----•----•---------- <br /> -----------------------------•-- -------------------------- - -- ------.--- <br /> - --- <br /> --------------------------- <br /> ----------- <br /> ------------------- <br /> ------------ <br /> ----- •---------------------------- ----------- - ----•---- <br /> i ----------------------------------------------------- --- ------ <br /> FINAL INSPECTION BY:- ------ '---- -' <br /> -------- <br /> Date.---- 1_2_ 6 --------- ---------- <br /> ISAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Lodi,California Manteca,California Tracy,California <br /> Stockton,California <br /> F.P.cn. <br />