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w <br /> ION FOR SANITATION PERMIT Permit No. __''. / J <br /> (Complete'iri Duplicate) Date Issued _6�1 " {{ .�`ZI <br /> V �� ­- . <br /> San-Joa uin Local Health District for a permit to construct <br /> Application is hereby mad he q and install the work herein described. <br /> This application is made ' co plia,nce with County Ordinance.No.-1549. " <br /> 3 <br /> � - ---rte- <br /> k JOB ADDRESS AND O . ION„1I. ----- l - • _571c;/67 ---------P - !` (�/^ <br /> 7, l off qtr; ..- T---- - - -------------- one <br /> -� <br /> Owners Name---- � �= -- - ---------' - <br /> �r Y.. <br /> ----------------------------------------------------------------------- <br /> Address--------- C�- -----------G----- �------- - -- <br /> Contractor' . ame.- ---- .� k -------------------------= --- ---:------------ Phone---------------------------- <br /> < �! <br /> Installati wil sere Resiclence Apartment House ❑ Commercial [I Trailer Court El Motel [3Other El <br /> Numbe living units: - -f->rL <br /> __.__ Number of bedrooms __?-- Number of bathsd_ - of size ____s�_ __ - F - ----------------------- <br /> Water Supply: Public system ❑ Commun'ity system ❑ PrivatelSv Dep�h to Water Ta61e 4'_ ft. <br /> Character of soil +o a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: Yes E] No New Construction : YeN No ❑ FHA/VA: Yes ❑ N <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> 7 f <br /> (No septic tank or'cesspool permitted if public sewer is available within 200 feet <br /> .1 <br /> . <br /> _ - ---------- <br /> Septic T nk: Distance from nearest well_________Distance from ------- <br /> foundation___ ___-______.Materia4___ _ <br /> No. of compartments---------_ -----•---Size__�_ __. _X. __Liquid depth-----` --------- - -----Capacity____-,. ��-----_-- <br /> 1 I f ��.____--Distance to nearest lot -- <br /> 1 Disposal Field: Distance from nearest well;___,______-__Distakce from foundation___-_ ___ �-- <br /> ' Number of lines----- - ---•------------ Leng"tli�of each'line------ -- -----�q--------Width of trench__- t-- <br /> Type of filter material ---- `-Depth of filter material______C_ ____________Total length________ ____ -!` ----------- <br /> Seepage Pit: Distance to nearest well--------------------i-Distance from foundation--------------------Distance to nearest lot line----------------- <br /> ❑ Number of pits ------Lining material-l--------------------Size: Diameter---------- ------------.Depth--------------- --------------- <br /> r, Cesspool: Distance from nearest welh__ff:"'_'_Distance from foundation--------------------Lining material-----------.------------------------- <br /> ❑ Size: Diameter - 4 ;, <br /> -:_ � '--:----!-Depth----------------------------------------------------Liquid Capacity- - ----------------- gals. <br /> Privy: Distance from nearest well s_-.__ -____ ____________f-___.--------------Distance from nearest building------------------------------------------- <br /> --------------------- <br /> Distance to nearest lot line_._.-rye- ` ----- --------------- --••-------------------------• - <br /> i r: <br /> Remodeling and/or repairing (describe)�-------- ---�--f--�+ ------------- ---------------------------------------------•----------------------------------------------------------------- <br /> I <br /> ---------------- ------------------- ---------------- <br /> ------------ <br /> - - ------------------------------------------------------------------------------------------ <br /> I -------------- <br /> ------------------------------------------------------•--•--------------•-•--------...__•-----=--- <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 and regulations of the San Joaquin, ocal Health District. <br /> 1 `- ------------------ <br /> Si ned x- `t� "----------------------------------- <br /> By: <br /> -----------------�----- (Owner and/or Contractor) <br /> ( 9 �---------------------- ------------. ------- - --------------------------------(Title) <br /> (Plot plen, showing size of lot, lots+ion of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- -Wil'`'------------------- ---------------------------------------- DATE------- = j �� T --------------- <br /> REVIEWED <br /> ------------REVIEWED BY----- -•-----------------------------------------Ir---------------I--- ------------------------------------------------------ DATE-------------------------------•------------•------------- <br /> BUILDING PERMIT ISSUED------------------------- ------------ DATE----------------------------------------------------------- <br /> Alterationsand/or recommendations----------- ----------------------------------- --------------------•-----•---------------------------•------------------------------------------------------- <br /> ----------------------------------------- <br /> ------------------------------------------- - ---- ---------- "-------------- ------------------------------------------------------------------------------------------------------ <br /> �-�---_---------------- --- ----- ----- <br /> ----------------------------------------------------- <br /> ------------------------------- �� - --------------------------------------------------- <br /> --- ----- - -------- - --- -------------------------- <br /> ------------- ------- --- ------------------------- <br /> Date--.------, _ C " -------------------------------------- <br /> - <br /> FINAL INSPECTION :_ _____ .n-�----��?---- ------------ - ` <br /> i <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 3 300 West Oak Street 132 Sycamore Street 814 North "C' Streef <br /> Stockton, California Lodi, California Manteca, California Trai y, California <br /> ES---4-2M , Revises 1-57 F.P.CO. . <br /> f <br />