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FOR OFFICE USE: n ~ <br /> ------------- -------------- / <br /> -.---------- APPLICATION FOR SANITATION PERMIT Permit No. 1�I? <br /> ...... --- ----- .......... (Complete-in Duplicate) <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 /> This application is made in compliant ith County Ordinance &. 49.; ~ =P •+ <br /> JOB ADDRESS A LOCATIO {_ ._-- � Al- -_ --•--1-- Cf�f <br /> rr., �/ <br /> Owner's Name L�!--PP --- -5---1.4 4----------------- --------- ----- --------- Phone__f�� __/-/--`-'- f <br /> Address_____________ <br /> Contractor's Name------ -PA'- _k+ _Is _. _... 'mss' �., _1 Phone . _ <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> >, ,Number of living"units: - -- Number of bedrooms __- Number of baths _-i�_--- Lot size _A_a_P___CA_G_ _______________________ <br /> Water Supply: Public system ❑ Community system•❑ Private 4 Depth to Water Table.rl..0 ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam 0 Ciay Loam'X Clay ❑ Adobe ❑ Hardpan ❑ <br />,k Previous Application Made: (If yes,date------------------- ) No"O New Construction: Yes ❑ No FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> {No septic tank or cesspool permitted if public ewer is available within 200 feet.) rsr <br /> Septic Tank: Distance from nearest we L' -00----Distance from foundation__ __ <br /> p �„ /jo--------.Maferiilt --- ------------ -------- - � <br /> No. of compartments___ --------- -....Size.... __ __ __ _ .___Li Liquid de th__:Z_._. ,__. 0--,. <br /> q - CapecitY= == <br /> t <br />: Disp I Field: Distance from nearest well-1-44----Distance from foundation_ 10�__._.-_..Distance to nearest lot line_ ------- <br /> Tit, <br /> _..._. <br />' Number of lines.!�____. _ Length of each line-_._ !�_. �� Width of french �l�__________________ <br /> �i° <br /> Type of filter material. .O.�-__ _____Depth of filter material....___. __.___.___Total length____ ---1�-------------------------- <br /> Seepage Pit: 4 Distance to'nearest well___--------------------Distance from foundation--------------------Distance to nearest lot line__.____-_______- <br /> ❑' Number}af pifs__j-------------------Lining material.--------------------- Size: Diameter----------------- -----Depth-------------------------------- <br /> Cesspool: Distance from-nearest well ________________Distance from foundation.---------------- ..Lining material_____-.______-______.____.________.. <br /> F ❑ Size: Diameter... - -- ----- ---_----------De th---------- ----- - ---------------------------------Liquid Capacity----•----------------- ---gals. <br /> Privy: s Distance from -nearest well_______-------__.........._............_---------Distance from nearest building.--------_---______.___________-..._..._. <br /> . -, 1 <br /> ❑ Distance to nearest lot line . -------------- -------- -- <br /> # a <br /> Remodeling and/or repairing (describe: -- -- - - ---------- <br /> t-------- <br /> - <br /> - <br /> e-- -- --- <br /> ----------------------------------------------------- <br /> ° ----- ---------- ----------------------- - - ----- -------------------- ---- <br /> -------------------- <br /> I hereby certify that I haze repared 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 Local Health District. <br /> AM <br /> LS <br /> ------------------ k - - ._ �_.I - <br /> (Signed) t, - --------------------- {Owner and/or Contractor <br /> y - -_(Title) ....... <br /> Plot plan, showing size of lot,.location of system in relation to � � <br /> By:--------•------- •----------- - i" - _ <br /> [ p g y wells, buildings, etc., can be placePreerse side. <br /> t <br /> FOR DEPARTMENT USE O Y <br /> APPLICATION ACCEPTED BY = A---------- ------------- =.- ---- -------------- DATE------ �-77 1 <br /> REVIEWEDBY - - - --------- --------------------------------------------- ---------------------- DATE---- <br /> BUILDINGPERMIT ISSUED---------- --- --------------------------------------------------- --------------- ------------- DATE------------------------------------- -- <br /> Alterations and/or recommendations:_------------- ......... ---- ----­ --- - ---- --------------------------------------------- --•-•------------------------•---- <br /> -•---------•--------------------------------- ----------------- ------------------------------ ----------------------------------- --- ------------------------------- <br /> I <br /> 'I <br /> -------------------------------------------•------ -- ------ <br /> - -.-- --------------------------------------------------- - --------------------------------- ----------- ---- <br /> ----------- ---------------- -- ------ - - •- ------------------------------------ ------•----------- <br /> ------------•---------------- <br /> FINAL INSPECTION SY:.0Date--- r ? <br /> ------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br />