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FOR OFFICE USE: <br /> ------------------------ <br /> /` _s--------_x,'_3'0- _ _ APPLICATION 'FOR-SANITATION PERMIT Permit No. <br /> ----------------- ----------------------------------- (Complete in Duplicate) <br /> ....................---------------------------------- --- This Permit Ex ires 1 Year From Date Issued Date Issued 1�.-. .----- <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 /> ------- <br /> Owner's Name / ---- - ---•- ' Phone <br /> -- ---- -- - ------------------------------------------------------------------------------- <br /> Address------------- - - -------------- <br /> -----------•-----•-----------------------•---- <br /> Contractor's Name---I..---•- `--------------------- Phone-------------------------•-------- <br /> Installation will serve 3 t Residence Rt Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of;liviAg units: Number of bedrooms N7-_ Number of baths A- Lot'size/V� /g'29 <br /> Water Supply: Public system ,Community system ❑ Private ❑ Depth to Water Table ✓�i.�_ ft. —' <br /> Character of soil lf�o.adepth of. feet: Sand E] Gravel El Sandy Loam El Clay Loam E] Clay.❑ Adobe �ardpan E]Previous Application Made:' (If yes,date------.-------------) No Er—New Construction: Yes [-INo WR�'`PHA/VA: Yes ❑ No Z�.— <br /> TYPE OF INSTALL'-ATIONJANI7.SPECIFICATIONS: <br /> (No septic .tank or cesspool permitted if public sewer is available within 200 feet.) I <br /> t =, i <br /> Septic TAnk• Distance from nearest well-----------------Distance from foundation-- -----.----------Material-------_-----...--.-.-..._..-----------_____-__-. <br /> -�No. ofcompartments---------------.-----------Size-------------------------------Liquid depth--------------------------Capacity---------------------- <br /> 7 <br /> Dis osal_I=ield: 'Dista-nce from nearest„well-----------------Distance from foundation-..__..__..--------Distance to nearest lot line----------------- <br /> fi <br /> Nun•iber of lines--��---' <br /> --- ------- ----- <br /> ------Length of each line------------------------------Width offrench.-------------.----------------- ----- - <br /> Type,,of filter material.-._-______-_______.__-Depth of filter material.................__--_Total length------------------------------------------ <br /> x <br /> Seepage Pit: Distance to nearest well----—----- Distance f m f undation_.� � / � <br /> --.. ...�..._-- Distance to nearest lot line./ <br /> �um'b'er of pits._./--------------Lining material ...Size: Diameter. Depth c <br /> `x <br /> Y, Cesspool: -Distance from nearest well-----------------Distance from foundation--------------------Lining material-....--.---_-- ---------------------- <br /> El <br /> --_--.-..--.-------❑ Size: Diameter----- ---- ------ -------- ----- ----Depth- ------ - ----------------------- <br /> ---- -------------- - -------- ------- Liquid Capacity- ----------•--•------------gals. t <br /> Privy: Distance from nearest well------------------------------------------------- from nearest building-----------.---------------------..-.-.... <br /> ❑ Distance to nearest lot line---- -----= ------------------------------------------------ ------------------------------------------------ <br /> Remodeling and/or repair ng�(d'escri�e):------------- - ---------r- -- -� -------- <br /> -------- - ----- - I,� <br /> e- . <br /> f�----- <br /> ------------------------------------------------- ut ' <br /> -- --elf <br /> ----------- l-------------------------•--------------------------------------- t <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, State laws, and rules an'd regulatio of the San Joa in Local Health District. <br /> [Signed)------------------ ------------------------ ��. r �uf�Ge --------------- ----•---- --” /or Contractor) <br /> By:-------------------------------------------1 '------------------------------------------- T ---=----(T.itle)--= t <br /> (Plot plan, showing size of lot, location of system in relation t ells, buildings, etc., can be placed on reverse side). E <br /> ,r <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-=------- ' ---------------------------------------------------------------------- DATE- // '�y/�-S__ --------------- <br /> - - <br /> REVIEWED BY----- ------------------- ----- -----_----- ---------- <br /> --- <br /> ------------------•------------------------------------------------- DATE----- ------------------------ <br /> = - <br /> BUILDING PERMIT ISSUED-----------------;----------------------------- DATE----------------------------------------------------------- <br /> Alterations and/or recommendations:!.... / 4 G.s �J - ---------------•------------------------•---------------- ........ ------- <br /> 'j <br /> t <br /> r <br /> ------------------`------------ ------------ --------------------------------------------------- <br /> --------------------------------------------------_----------------------------------------------------------------------------------------------_.------------- <br /> FINAL INSPECTION BY: /� �7 <br /> ------ Date--.-- ------- <br /> i <br /> SAN-JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West k'Street - `124 Sycamore Street 205 West 9th Street <br /> x <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.0 0. j+ <br />