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*z;1— FOR OFFICE USE: - <br /> = APPLICATION FOR'-SANITATION PERMIT <br /> Permit No. <br /> r� ------- ---- <br /> i � q <br /> ------------ <br /> r <br /> -------------- (Complete in Duplicate) Date Issued -' --/------ <br /> ----- This Permit Expires 1 Year From Date issued <br /> Application is ereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This Cal' n is made in compliance with County Ordinan e No. 549. <br /> �[20! v� �� tZ� PC1D -tQ3 <br /> ., ------------------ <br /> JOB ADDRESS AND LOCATION----------- F - � .. '`' T-t --------- :" ,�y� <br /> Owner's Name-----------------------/'1-1-------&A1.4_-+----- --- --------- --------- Phone-13��� �7-�� <br /> f3 <br /> Address--------------------------------------? ?. - ------------- <br /> --------=� +o-------------- <br /> Contractor's <br /> ---------------- <br /> Phone-__-----------------•--------- <br />_ Name--------------------------------••--- �• ---------------------- <br /> --------------------------------------------------- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: --1---- Number of bedrooms -9_-- Number of baths ----L Lot size - Abw - <br /> Water Supply: Public system 171 Community system El Private ❑depth to Water Table _la ft. <br /> i <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel El Sandy Loam Clay Loam ❑ Clay ❑ Adobe E] Hardpan ❑ <br /> Previous Application Made: (If yes,date---------------_---) No Q New Construction: Yes ❑'No 0 FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> - {No septic tank or cesspool permitted if public sewer-is available within 244 feet.) <br /> Septic Tank: Distance from nearest well----JO-------Distance from foundation------ - -------Material----GC>J _4R - ---- - <br /> ------a I-'-----Size--�[9� ��_Y _Liquid depth--------49.z--------Capacity---1,2�----- <br /> No. of compartments_- - � - � <br /> Disposal Field: Distance from nearest well---Vrb*- --.Distance from foundation--_--/?-_---_--Distance to nearest lot�e----S--_------ <br /> [� Number of lines----- Length of each line----------$0-- -------Width of trench- --- ------•----------------- <br /> r <br /> I <br /> Type of filter material- .- ti- Pte--Depth of filter material------ -----_Total length------ilk- ----_------------------ <br /> Seepage Pit: Dis#ante to nearest well-- Distance from foundation-------------------.Distance to nearest lot line_--_---------_.-_ <br /> ❑ Number of pits----------------------Lining material---------- -----------.Size: Diameter--. Depth - --- ---- --------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation------------------ Lining material--..._---------.--------------------- <br /> ❑ Size: Diameter---------------------- --------------Depth------------------:--------------------------------Liquid Capacity:- -------------------------gals• .. <br /> � .._-_���.,_ -" ,� -✓ ®.s.- -------------------- <br /> Privy: Distance from nearest well---_-_._----- ___----------__-------------Distance from nearest building.- <br /> ❑ Distance to nearest lot line-- --------------- ------------------- ------------- <br /> Remodeling and/or repairing (describe)---------------------- ---------------------------------•---------------------- ---------------• <br /> ------------------------------- <br /> -------------------------------------- <br /> ------------------------ <br /> ----------------------------------------------------------------------------------------!-------------------------------------------------- ------------------------------------------------------------------------------------ <br /> --------- --------------- <br /> ---------------------------------------------------------------------- <br /> - ----------- -- ----------------------------------------------------------------- -- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin oun+y <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> ---------------- -- wrier and/or Contractor <br /> (Signed)----- ------------- - ------------------ ------ � --•-------------------------1---------------------- <br /> -.-(O <br /> _ ---------------------------------------(Title)------------------------ ------------- <br /> By:--� (Plot plan,`sl7owingsize'of lot,location-of'system"in relation t wells,'buildings, etc., can be placed on reverse side]:' <br /> FOR D ARTMENT USE ONLY <br /> APPLICATION ACCEPTED B --------- DATE-------- --- ------ ---- ------------ --------------- <br /> REVIEWED Y -------------------------- --------- - ---------- ------------------------ ------------------------------- <br /> ---- DATE----------------------•----------------------------------- <br /> BUILDING PERMIT ISSUE ------ - DATE <br /> Alterations and/or recommendations:------------------ --------------------- -----------------------------------•-------------------------••--------- <br /> t / .-, <br /> r FINAL INSPECTION :---- -- Date-- ---- q-``7-- -�--6----------- ----- ---------------------------- <br /> SAN AQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Kaxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />