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FOR OFFI E USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No. ....1:T-_..�J.. <br />------ -------------------------------------------------- (Complete in Duplicate) Date Issued .._�_...7��� - <br /> ll�� <br /> r <br />------------------_-----------..__._.------------------- This Permit Expires ] Year From 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 incompliance with County Ordinance No. 549. f <br /> JOB ADDRESS AND LOCATION------- eRR-•--•-------------------- •+ ,TG^[°:1� ?. e�..-•-•-----••-•. •-•------- <br /> Owner's Name'.....A;'I----- .------•------------------- ----------------- •----------- -------------------------------------------- Phone.a! .70..21.0• <br /> Address--..-.----------- -----=------ --- __.._.....---------------------',..-�--�----C.....-"/!''-.....-......................................-...............................•------- <br /> Contractor's Name-------- �__._sO.:.TF1 ---------�� -................................... Phone----------------•-•-- <br /> Installation will serve: Residence 's Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel' C] Other ❑ �� <br /> Number of living units: ._!___- Number of bedrooms ---Z7:. Number of baths ---I--- Lot size ------- ,K...... .................. <br /> Water Supply: Public system ❑ Community system ❑ Private D) Depth to Water Table. ;�P ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: (if yes,date___________________) No 14 New Construction: Yes ❑ No X FHANA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <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----------------1___.Material................................................. <br /> ❑ No. of compartments--------------------------Size.............-------------------Liquid depth------------ ...............Capacity....................... <br /> Disposal Field- � Distance from nearest well-14V--- Distance from foundation <br /> r_.�...Qlstance to nearest lot line....`�r...... <br /> �' iT Number of lines_______ ___-_j__ ____ ___________Length of each line________._!________._:.Width of trench.........1 S 1-"•_.-_-----•.-.. <br /> APU Type of filter material._._.�aS �.___Depth of filter materiaL_.... length..............L-S._..__........__..____ <br /> Seepage P-t:. Distance to nearest well------)_"_`___.Distance from foundation-----& .11_.Distance to nearest lot line____., ..�.__.- <br /> (� Number of pits____________________Lining material_Ro.t-IC-----Size. Diameter:.._._ + Depth---------- <br /> Cesspool: Distance from nearest well•________________Distance from foundation---------------___.Lining <br /> ❑ material.._ ...__...__._.______________--•-. <br /> Size: Diameter------------------------ -•---------De th--------------------------------- ----------I---Li Liquid Capacity ..---gals. <br /> I <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest buildinq----------------------------------------- <br /> ClDistance to nearest lot'line-------- __' -- •" - 1 <br /> } <br /> Remodelingand/or repairing (describe):------------------------------------------------------------------------------------------------ ....................................-------........... <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 Local Health District. <br /> (Signed) ------ ,2 Mr C. ---------------------------------------------(Owner an or Contractor) <br /> iBY: �` ----------------------------------------.....------------------(Title)------g-._---- ----- - ---------------- <br /> (Plot plan, showing size of lot, local' n of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> t FOR DEPARTMENT USE ONLY ' <br /> APPLICATION ACCEPTED BY------ --' ----------------------------- ----------- DATE'----to----•-q- Sp�",- -----• --------- <br /> REVIEWED BY...._. t ------- DATE..-.--•...................................................... <br /> BUILDING PERMIT ISSUED_---_--= - DATE----------•-------------- - - -- ----- ----•----- <br /> 1 Alterations and/or recommendtalions:--- -------- <br /> (g---1 :---fir-Zl s. _.__!]+t. .�.4�r` -41!4..--•--=----- 4- cce __.._ k_1_ .__ .u.� �y--------- <br /> '.�.. + * , 1--------------- <br /> 1 F' <br /> 1 - l sr t lI <br /> I - -if ,i ! <br /> LQ . 0► _ I <br /> FINAL INSPECTfON"BY: � -5 ---- �.. . Date. � __--- �- Z---------------- -- -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Strout 300 WestOakStreet 124 Sycamore Strout 205 West 9th Street <br /> Stockton,Californla Lodi,Cal fornia Manteca,California Trary,California <br /> ED 9 REVISED 8-89 MM 5-61 ATLAS <br />