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FOR OFFICE USE: <br /> G <br /> ------------------------ K <br /> .., �� 91'Z t <br />------------------------------------------------ <br /> APPLICATION FOR SANITATION PERMIT Permit No. ....................... <br />------- ------------------------- ----------------------- (Complete in Duplicate) <br /> Date Issued _y_.�__-___� ` <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�escrb/ecl ;I <br /> Th-is application is.�made in compliance liance wit County Ordinance No. 549. <br /> IC7 C� <br /> � --� ------------------------- -ADDRESS AND LOCATION-_--_-. ---------------------------- <br /> Owner's <br /> -------------------- --'-•- � <br /> ------------- - ----- - - - ----------- <br /> FB/e ----------------- ------------------ -------------------- -- Phone----------------------------------- <br /> Owner's Name------G��r✓c------ ��-�-•---�---------------------•- ----•- - - <br /> Address---• ---- ... L - �--S---... -—4 7---- =---S-Toak-Ta-------------------------------------I-------------------•--------- <br /> Contractor's Name--Aq/%Fi-(---------------------- --------------------------- Phone......------------•------------•--- <br /> Installation will serve: Residence ❑ Apartment House F] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -------- Number of bedrooms .3-___ Number of baths -------- Lot size --.3--A_C� s-------------------------- <br /> s <br /> Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table -------- ft. i <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes'o No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: " <br /> (No septic tank or cesspool pelmitted„if_public sewer is available within,200 feet.) i <br /> �7 a.. <br /> Septic/Tank: Distance from nearest well--- -Distance:fr&mfotin�lation-— .-_.__.Material-----669N616� _______--_-. <br /> ( .. <br /> No.,of compartments- /C' .-_____'--Size-_ X1,0 :-�-___Liquid depth_::. __��,.-._-...---Capacity---1- d_____ <br /> Dispos I Field: Distance from nearest we' ll--Sl ---!-_Distance from foundation--_-/ ------ <br /> -__kDistance to nearest lot line-------------- - <br /> EW Number of line ----- - -Len ✓� d V/t---------' G <br /> s_-_--'-_-- `--Length of eac line--------------- --------------Wi Width of trench------ <br /> Type of filter maternal---_�lrG�..-_Depth of filter matenaL-_.-� ._____---:Total length �_--_--____--_---- --- i <br /> Seepage Pit: Distance to nearest well- ---- --------t__Distance from foundation----- -_------.Distarice to nearest lot line-------------- (p <br /> ❑ Number of pits-----. --' Lining hmaferia{--------------'------- Size: Diameter----: -----------------Depth--------------------------------- <br /> Cesspool: <br /> --------------------------------Cess ool: Distance from nearest well-----------------D•stance from foundation- _. ------ ----ALiniF g <br /> material------------------=------------------ I <br /> F1Size: Diameter -------•••--..- ------------ ----Depth------------ - ------__ Liquid Capacity-----------------------=---gals. <br /> 'Privy:, Distance from nearest well---------------------------- ------Distance from nearest building------------------------------------------ <br /> ❑ Distance to nearest lot line----------- -------------------- - ------------------------------------------ ------------------------- --------------` <br /> r - _=--------------------- --------------------------------------- i <br /> Remodeling and/or repairing (describe}:__-.------_---------_---.__----------_ <br /> -"" ------------------------------ a <br /> --------------------------------..-----.-.--------------------------------------------------------.--------•--------------------------- -------------------, x-------------.----------------`------------------- <br /> rge�e6yy certify fhat-lYh-ve prepared-this application and that4the work-will-be done in accordance with.San Joaquin County <br /> a <br /> q tY <br /> ordinances, State I ws, and rules an reguia 'ons of the San Joaquin Local Health District. <br /> Signed)----- -- - ----------------- -------------------------------- --------------------------------------- -------- -------(Owner and/or Contractor) <br /> By:----------------------------------------- -----------------------------------------------------------------------------------------(Title)---------------------- ------------- -------------- <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 /> APPLICATION ACCEPTED BYoWRQ --------------------------------- DATE------�_`- _-- v <br /> REVIEWEDBY----------------------------------------- - -------------------------- ------------------------------------- ------- DATE--------- --------------------------------------------- <br /> BUILDINGPERMIT ISSUED-----------------------_•---------------------------------------------------------------------------- DATE------------------------------------------------------------ <br /> Alterationsand/or recommendations-------------------- ------------- --- -----------------------------------------------------------•----- -------•--------------- --------------­------------- <br /> -------------------------- ....­------------------------------ -------------- I----------------/' <br /> FINAL INSPECTION BY:- 7:9// ------ - -------------------- Date---------- `5 �`��� - ------- ----------------- --------- <br /> f SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Na:elton Ave. 300 West Oak street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />