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FOR OFFICE USE: _= Permit No. ..."____....-.- .. <br /> APPLICATION FOR SANITATION PERMIT <br /> q 3 •� <br /> -- - ------- --- ------------------------------- (Complete in Duplicate) J Date Issued _5�I -. <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... / 1.4?----- - <br /> O/`-�c---------------------------------------------------------------------------------------------- <br /> Owner's Name­'le ------�E- -�-��---'-------------------------------------------------------------- - ------------ <br /> ------------ Phone --•------ <br /> } Address__ S,f 1`7--- -------------------------------------------------------------------------------------------------------- ------------- <br /> r <br /> one ------- <br /> � '. � l us oto... <br /> Contractors Name-.-- - <br /> I <br /> Installation will serve: Residence �$ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: -1------ Number of bedrooms j_.- Number of baths j.." Lot size ------�.2��.-�. '/er----------------------------- <br /> Water Supply: Public system Q .Community system ❑ Private ❑ Depth to Water Table -------- ft. <br /> I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe R Hardpan ❑ <br /> Previous Application Made: (If yes,date-..--.-"- ---------.) No New Construction: Yes D4 No ❑ FHA/VA: Yes ❑ No ❑ <br /> t TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.)r <br /> Distance from foundation..-Zo-.-.------Mater <br /> Septic Tank: Distance from nearest well i f� <br /> No. of compartments - Size y�----------Liquid dpth Capacity- 1 5' <br /> Disposal Field: Distance from nearest well._.... ... ---Distance from foundafion..1.-._--._....Distance to nearest lot line:_-------------- <br /> Disposal <br /> .�....." <br /> Number of lines---------- ------------------------Length of each line--.------" -- - Width of trench..._2=- /------------- ------ <br /> of filter material----n�,oa/�.....Depth of filter material------ ---/----"--Total length-------- ---------------------- <br /> Type \ <br /> - / A- I <br /> Seepage Pit: Distance to nearest well..-. .__....-_Dista to from founds n..-.18......"--.Distance to nearest lot line-----�... <br /> Number of pits.---------/-..---_.Lining mater al------ <br /> 'S' Diameter---1 Depth �f�/. xX.�r, <br /> Cesspool: Distance from nearest well...- ".....Distan oundafion-------------_..-- Lining material------------------ .....". <br /> ❑ Size: Diameter------ ----------- ------------- ----Depth-------------- -------------- --------------------..Liquid Capacity------------------ - ---..gals. <br /> Privy: Distance from nearest well--------------------------------------------------Distance from nearest building----------------------------------- <br /> ----------------------------- <br /> ----------------------- <br /> i.-"- -- <br /> ❑ Distance to nearest lot line------------------ - <br /> i <br /> Remodeling and/or repairing (describe]--------------- <br /> t - <br /> �A f ------------- ------------------ <br /> ------- i----'--�-•------------------------------•------------------------------------------------------------------------ ------ <br /> 6fZr ._....----•---- --_-/--�"'-`�=-_.-. r.I._.- ------"---------------------- •-------------- - •_--••------- ----.--------- ---. -----.-"------. <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin ounty <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. , <br /> ��/ <br /> y?�_ -------------------'--------------------------------------------- <br /> (Owner and/or Contractor) <br /> ------- ------------ <br /> F -------------------------------------------(Title)-------------------- ----------------- ----... <br /> By:------------------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side)._ <br /> 1 <br /> F R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED`BY._ --- ---- -- ------------- ----------------------- DATE. � � <br /> REVIEWED BY------------------------------- <br /> - ------= ------------ ...------------------- DATE----------------------------- ---------------------I;---- <br /> BUILDINGPERMIT ISSUED---- -: ---- ------------------------------------- DATE------------------------------------------------------------ <br /> Alterations and/or recommendations:----- ---- -------- -----------------------------------•---"---•-----------•---------------- <br /> t ----------------------------------------------------------------- ------•---------•----------- <br /> It ------ --------- ------------------ ------------------------------ ------ ----------------------------- <br /> ----------- --------------------- -------------- <br /> ---- -------- ---- <br /> ---------------------- <br /> ---------------- ... <br /> FINAL INSPECTION BY:.. - -'r.--- - -- -------------- <br /> Date----------- = s-------------------------------- --------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hasellon Arra. 300 West Oak Street .124 Sycamore Street 205 West 9th Street <br /> Stockton,California { Lodi,California Manteca,California Tracy,California <br /> F.RCU. <br />