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x FOR OFFICE USE: <br /> --------- ------ <br /> "'. <br /> APPLICATION 1=0R SANITATION MT <br /> OIIII <br /> Permit No: _._A <br /> --------------- --------- -------- --------- <br /> (Complete-in Duplicate) ,. <br /> This Permit Expires 1 Year From Date Issued <br /> ----- ---- --�-------� --� --..._- ------ bate Issued J <br /> Application is hereby made to the San Joaquin Local Health District for a permit to const and install the work in/descrb d� <br /> This application 'is made in compliance with County Ordinance No. 549. - <br /> 110, A <br /> JOB ADDRESS AN OCATIO / 4tcae - I <br /> - ------`--- ----- <br /> Owner's Name____ __ <br /> - -------•-------------- ------- - ----- -- --I- - Phone �----------------•--------•--- <br /> Address------------- <br /> "' ` <br /> Contractor's Name____________ `-" _.____-____._. Phone------ ' <br /> Installation will serve: Residence Apartment ouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __/--- Number of bedrooms 3.- Number baths _ Lot size <br /> -----•------- <br /> ). <br /> Water Supply: Public system E] Community system E] Private Depth _ ater Table.__ _.__ _ ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel E] Sandy Loam Clay Loam E] Clay ❑ Adobe Hardpan <br /> Previous Application Made: (If yes,date--................. ) No ❑ New Construction: Yes E] Nc"h FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: f <br /> (No septic tank or cesspool permitted if'public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well_!______________Distance from foundation--------------------Material ----------------------------- <br /> ---------------- <br /> El No. of compartments..............._ SizeII <br /> -•-------------- -----------Liquid depth-- --- -----.Capacity-----------•----------- <br /> Dispos Field: Distance from nearest well_.., __l....Distance from foundation.-_-�P_�____._.Distance to nearest lot line___`S__�____ <br /> Number of lines ----------/__--- ------ _ Length of each line.------70----------------Width of trench-�_.-.-------------.---- <br /> Type of filter material-------s_� _"__-.-_-Depth of filter material.___ " <br /> p / Total length ----------------------------- k <br /> Distance to nearest well_._ cp.- -._ _-Distance from foundation --------Distance tp nearest lot line_.S'' <br /> El Number of pits_-- --. .-.Lining ,materiaL_..r _ _-_-_.. Size: $wAFer. _�X ld-_--Depth..... <br /> Cesspool: Distance from nearest well --------------__Distance from foundation---------........ ..Lining material------------------------------------- <br /> El <br /> _______________________________ ___❑ Size. Diameter. _. ------ _ <br /> - ---------�-�- --=._Depth - ----'-- -----Liquid Capacity----------- - ------------gals. -..: <br /> f, —. l , <br /> Privy: Distance from.nearest.welL___ ____________ Distance from nearest building-,-------- g------- ------------------------------- <br /> ❑ Distance to nearest lot line ------------- - <br /> �4 � F <br /> Remodeling and/or repairing (describe):------ <br /> ----------- <br /> fF? ---------------------------------------- <br /> _ <br /> •------•--------------------- <br /> -- ------------- ------------------------­ •-------- ----------------------------------------------------------------------------------------- -------------------------- <br /> I hereby certify that 1-have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Sta ws, and rules an;rulations of the San Joaquin Local Health District. <br /> (Signed)--_-• --.-------�<- --{6rrner-an / r Contract ) <br /> d o or------ ------------ --------------------------------------(Title)---------- --------------- -- <br /> (Plotplan, sh wing size of lot, locatisystem relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY._._. . <br /> ,��n�'-- ---- ------- --- DATE a ��' - <br /> REVIEWED.BY -------- ---------- ----- ------ DATE-- <br /> BUILDING PERMIT ISSUED------ ------ ------ DATE <br /> Alterations and/or recommendations:_._____................. . <br /> ----- -- ------- ---------------- ----- r <br /> ---- -- ------------- ----------------.................... - - I <br /> ------------- ---------------- <br /> FINAL INSPECTION BY:_._.- F , - <br /> .-�'"`" --- -------------- <br /> -Dete�'1 G� fC? 1 <br /> :: .=... LP <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ha:ellon 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 t-til Vanguard Press i <br /> I 4 <br />