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FOR OFFICE USE: � t., I. W <br /> W. --- ----------- <br /> o. <br /> APPLICATION FOR ISANITATION PERMIT" Permit N ........0 <br /> '4-L,�/ -, /d <br /> 7 (Complete in Duplicate) Date Issued _2/ <br />----------- 6_�A y__-_ ------ 7 �_ 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 compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND ICICATION----- ........ 2—- <br /> ------- --- -------- ------- ------------- --- ----- <br /> Owner's Name------ ..... ----------------- -- --------------------------I-------------- Phone/V-,o=Z=�-67 7 <br /> -------------------------------------------------­.--------•---------•-----------•---•----------••---- <br /> Address...7/ ----------------------------- <br /> Contractor's Name----- ------ <br /> Phone----------------------------------- <br /> ------------------------------------------------------------------------------------- <br /> Installation will serve: ResiclencetApartrnent House E] Commercial [] Trailer Court [I Motel/[] Other El <br /> ;7 <br /> Number of living units: __Z�Number of bedrooms At Number of baths —___ Lot size -------f <br /> _2 _________-._-__ <br /> Water Supply: Public system P-_`Community system E] Private E] Depth to Water Table �-r ft. <br /> Character of soil to a depth of 3 feet: Sand F] Gravel [] Sandy Loam [-] Clay Loam E] Clay E] Adobe Hardpan E] <br /> Previous Application Made: (If yes,date--------------------) No Lj-- New Construction Yes � No E] FHA/VA-. Yes E] No <br /> ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r. <br /> Septic Tank: Distance from nearest well___._2t`1"`5istance f�rom f9undation--------------------Material-------- - <br /> T, --- --------------- <br /> - --------- <br /> 7� No. of compartments-------------:?__--------Size____1_x_:17_ clepth-------ZI-1 Capacity.cJ-------- <br /> Disposal Field: Distance from nearest weII.'9tt7.7?,-�. isfance from foundation---/4y------Distance to nearest lot line-__.-�(.._...... <br /> Number of lines___-_ -----------------Length of each line--_____x _42-_-__-,--Width of trench_-______--�L/---- ----------- <br /> Type of filter material----- c_0__—'-.'_Depth of filter material......... -------Total length-______ --------------- 000. <br /> , <br /> Seepage Pit: Distance to nearest well.----------6----------Distance from foundation-------------------Distance to nearest lot line__.____.___-_.._. I <br /> F1 Number of pits----------------------Lining material------------- ---------Size: Diameter.----------------------Depth_.-____.___________-__-.------ %P <br /> Cesspool: Distance from nearest well-------------- --Distance from foundation... ----------------Lining material_----__.___------_____.________-___. <br /> Cl Size: Diameter------------------------------------:-Depth--------------------------------_------------------Liquid Capacity-----------r----------------gals' <br /> Privy- Distance from nearest well__________________ _________ _______________Distance from nearest building__________-____._„_________._.-_-.__.-_. <br /> ❑ <br /> uilding------------------------------------------ <br /> ClDistance to nearest lot line-------------------------------------------- -------------------------- --------------------------------------------------------------------- 0 <br /> Remodelingand/or repairing (describe)---------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------­------------------------------------------------------------------I------------------------•-----------•----------------------------- ------------------ ------------------•--•------------------------------------------------------------------------------------------------------------------ <br /> --------------------------------------------------------- ------------------------------­_-------------------------------------------------------------------------------------------------------------------------- ----- - <br /> I hereby certify that I have prepared this application and,that the work will be done in accordance with San Joaquin County <br /> ordinances. Stafe�1 , and rules and regulations of the San Joaquin Local Health District. <br /> {Signed}______ ----------- - ------------— ------------------ ----------------------------------------------------------------------------(Owner and/or Contractor) <br /> ------------- ---- -- --------- <br /> By:--------------------------------------------------------------------------------------------------------------__---------------- <br /> {Title)_ <br /> (Plot <br /> Title)-(Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> ---------- <br /> APPLICATION ACCEPTED BY-----------A -moi•---------- ------------------------------ DATE-----+— r �{ / = <br /> REVIEWED <br /> ATE------ <br /> REVIEWED BY-------------------------------------------------------- <br /> -------------------------------------------------- DATE----------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED-------------------------------------- ----------- _k----------------------- --------- DATE---------------------,----,-----r-.----------------------------- <br /> Alterations and/or recommendations'------ ----------- -_-------------------ma -- ------------- <br /> ---------- --------- ----------------------------- <br /> -- ------------------- ----- -- ----- A-------- <br /> ---- ----- ------ r-------- <br /> X --------------- -------I------------�t-------------- <br /> ------------- -C_7� <br /> ------- ----- ---- -- - ---------------- ------------------------------------------------- <br /> A_� -------------- ------- - ----- ...... ---C---------------------------------------- <br /> ------------------- -.---------I------'------------------ -------------- <br /> A­7 <br /> FINALINSPECTION BY------------------------------ ---------- --------------------- Date_- -------------------- ------------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haz*lton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 93.59 3M 3-63 r.p.ca. <br />