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FOR OFFICE USE: <br /> --------- ----- -- - - ------ -- �- <br /> --_--_-------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. _. <br /> I (Complete in Duplicate) Data Issued <br /> ...... .............. -----------I .111. 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 insta4l the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION- <br /> _ 3, / �-__p .� t ----•----------------------------•------------------ <br /> Owner's Name-- -L.°y�5'. 1�7s' ll_C� ------•----------------------- ------------------------------- ----- Phone----------------------------------- <br /> Address........ ---------•----•---------------------------------••---------------------------------------------------------------------------------------....--.------------------------------------ <br /> Contractor's Name-------... IB ,/ � ---------------------------------- -- Phone----•------.----•-•_--------------- <br /> Installation wili-serve: Residence ?�`Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _ _ Number of bedrooms �� Number of baths _/--- Lot size -- � --��-�____________________________ <br /> f <br /> Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table Q ft. <br /> Character of soil to a depth of 3 f6W. Sand ❑ Gravel ❑ Sandy Loam [❑ Clay Loam [❑ Clay ❑ Adobe @0-'Hardpan ❑ <br /> Previous Application Made: (if yea date____________________) No j2r^ New Construction: Yes ❑ No [??- FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted rif,public sewer is available within 240 feet.) <br /> Septic T n�;. Distance from nearest well__....... <br /> _. _ -------------------- _ <br /> . Distance from foundationMaterial__________________ __.___________--__----._.-_-. <br /> orad No. of compartments-------------- -------' SiZe--------------------------------Liquid depth------------ -- - -------Capacity-•------------ <br /> Disposal Figld: Distance from nearest well.--------- ------Distance from.-foundation--------------------Distance to nearest lot line_______.___.---- <br /> L Number of lines k________________________________Length of each:line---- -:_:.'" '___-'Width oftrench----------.------------------_.-___ <br /> Type of filter material-------------------------Depth of filter'material---.--------------- ..Total length------------------------------------------ <br /> See a i Distance to nearest well------_______Distance from fo dation__424e___---Distance to nearest lot ine- <br /> Number of pits.[---- ______________Lining material__ .air __.___f De tn_ <br /> _ size: Diameter._.___..._ p ' <br /> C sspoo : Distance from nearest well-----------------Distance-from foundation Lining material__--_---..---------.------_-_________ <br /> i ❑ Size: Diameter J----------------- - -------------Depth------ ---------------------- - -------- -------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well____________________________/._.._.____..___..D,�tance from nearest building.._._..._:_____._______-____.____.____._. ` <br /> ❑ Distance to nearest lot line_''" '...:"" _ " "� "" <br /> Remodelin9 and/or repairing (descr- <br /> ibe):----- - - <br /> ------------------------------------ - ---------------------------------------------------------------`---�------ <br /> ---------------------------------------------------------------------------------------- <br /> ----------------------------------- -------------------------------------------------------------------------------------------------------------- ------- -- --------- <br /> 1 hereby certify that I have prepared this application and that the work will be dome in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> {Si ned <br /> 9 )--------------------------------1_1�19F--(�---------�a - ------ - ---------- -- -- ------------------------------------------.__te%M=21:&d/or Contractor] #` <br /> BY: 4 --- + {Title] ------------------------------- -- <br /> (Plot plan, showing size of lot, location of system in r tion to wells, buildings, etc., can be placed on reverse side). <br /> 1­4 -FOR DEPARTMENT.USE,dNLY <br /> APPLICATIONACCEPTED BY----- - -------- ---------- - ------ ---------------------------------------------------------- DATE------ ------------------ _------------------------------- <br /> REVIEWEDBY----------------------------------------- -- ---- ---------------------------------------------------------------------- DATE--------------- <br /> BUILDING PERMIT ISSUED---------------- --------------------------- -------------------------------- - DATE. - ------- ----- -------- ----------------- <br /> Alterations and/or recommendations:__ - . --------------------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------- -------------------- ------------------------ ---------------------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------•---------------------------------------- ------ <br /> FINAL INSPECTION BY: r Date y 1--- 5 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> -0 .0% - . -t '_'. 4,"' � 4 t <br /> ,.1-601 CHa:eltori Ave.1W — 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.CD. <br />