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FOR OFFICE USS: <br /> ------- ---- -- <br /> -­-­--------............... .......... ---------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> - -------- - ------------- -------------- --------- (Complete-in Duplicate) 5` <br /> This Permit Expires 1 Year From Date Issued 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 /> f' This application is made in compliance with_ <br /> -. a�County Ordinance �N.o. 549. r <br /> JOB ADDRESS AND LOCATIO .51_ `_ �9CALOA( <br /> Owner's Name '--------- - -----_-- ----- --------------------------------------- Phone------------------------------------ <br /> Address..__µ ZO. F�� R � sT � RAn12Vc -AK-------------- <br /> K --------•---------. <br /> Contractor's Name.iN®0 - 5' TIC.. 5,F RV -- --�---- Phone <br /> Installation will serve: Residence �partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _ _._._ Number of bedrooms _. Number of baths Z-Lot sizeA_CA76 ---------------- <br /> Water Supply: Public system E] Community system E] Privater�D-epth to Water Table -7 ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam Z?0<1ay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: {If yes,date_.............. ... ) Nokj-�New Construction:fYes 2— ❑ FHA/VA: Yes E?I-'No ❑ <br /> -TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 700 feet.} <br /> Septic k: Distance from nearest well_1,�50_....Distance�fror'�rayfoundation..-/L9_-.-. /��l G E _ <br /> � t -_.-.Material --Lv__.. _('� _T <br /> No. of compartments ..Size__-/�. <br /> P Z.,--.,------- ,��' ���K-�.-----Liquidyy��depth.2�'7—.��--..._Capacity.�_J.�_..._r�.------- � <br /> Disposal Field: Distance from nearest well._ � ._Distance from foundation__0._._........DDistance to nearest lot line-_�- _---_- <br /> Number of lines.________ _____ _____�------Len th of each line__ _ ..____.___ _.-. Width of trench___._____.__.. <br /> ------ <br /> Type E O ------ P f # -Total length---- f, 0--------------------- ' <br /> T e of filter material. De fih of filter material_...-1_ <br /> Seepage Pit: Distance to Paresl well_... -___ ._Dis of nce from 6-5-n-8 ence to nearest lot line----------------- <br /> El Number of pits--- ------------------Lining material------------------ Size: Diameter---- ------------------DepA _.------------------------------ <br /> Cesspool: Distance frOM nearest well -_-_-.-.-. Distan'c rf�mft'8`R 0 ion__---..-_-.- --Lining material--------_---------------------------. <br /> ❑ Size: Diameter- -------------- ----------------D�Ah -_ ' -•^-'-L '`-- ----- --------..Liquid Capacity--------------------------.gals. <br /> Privy: Distance from nearest well------------------ --------- --�---- ----Distance from nearest'building------------,----_-----------------------. <br /> ❑ Distance to nearest lot line - -----------=---------- --- --- <br /> J. <br /> Remodeling and/or repairing Idescribe):-------------- '------------------------------------•--------- r - <br /> - ---W--= - ------------ ----------------------------------------------- <br /> ----------------------•-------------------- <br /> = ----_- -- - I G <br /> ." ?' o'"-_a `==',2 "`,= ---- ----------------- <br /> hereby certify that ! have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and6r'eg_ulatioris of the San Joaquin Local HealtW District• <br /> (Signed', ---- -- # ---- <br /> ------- ...(Owner and/or Contractor) <br /> ---- ( --- �'- <br /> (Plot plan, showing size of lot, cation of system in relation to wells-,,buildings,: etc., can beTlaced on reverse side). 4 <br /> FOR DEPARTMENT Ott-ONLYNL <br /> 1 <br /> r, <br /> APPLICATION ACCEPTED BY------_- �.1.'�- "' ,a - I.__ DATE-- ._- <br /> - <br /> REVIEWED BY : - -... -; : ---�-- 'i-------(----- DATE <br /> BUILDING PERMIT ISSUED ----------------------------------:------------- -------------------------------- I--- DATE-- f ------------------------ ----- <br /> I1 <br /> Alterations and/or recommendations:` -- ----- ------------- ------------------------------------- - ------=-------- ----------••-- F----------------------- <br /> ------------------------------------ ---------•--------- - <br /> _________ q V _ 5 --------------- <br /> FINAL INSP -- -------- --------- Date........... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California _ Lodi, California Manteca,California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br />