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FOROFFICE U5E: <br /> =� =AK-------------- 3: <br /> _- <br /> ---------------------------------------------------- APPLICATION FOR. SANITATION PERMIT Permit No. -4'-_l1-105 <br /> --------------------------------------------------------- (Complete in Duplicate) <br /> Date Issued <br /> ----------------------- -------------------------------- This permit Expires 1 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 in compliance with County Ordinance N�Al# <br /> 544 <br /> JOB ADDRESS AND LOCATION ------ - ---- <br /> Owner's Name L �-------- ---- ---- ------- ---- -------- ne <br /> Address-------------- �1.� - ---------------- <br /> Contractor's <br /> ------------Contractor's Name_____ _________ <br /> --------- ------ Phone-------------------- <br /> Installation will serve: Residence ❑ Apartment House [-] Commercial E] Trailer Court ❑ Motel ❑ Other [�r <br /> Number of living units- ---- N tuber of bedrooms -------- Number of baths _rZ--- Lot size _-._- 1 fpP-------------------------------:-__ <br /> Water Supply: Public system Community system ❑ Private"❑ Depth to Water Table :_._____ t. <br /> t <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe n —Harclpan ❑ <br /> Previous Application Made: (If yes,dote--____.___,__.._--) No New Construction: Yes [ Flo-]_ FHA/VA: Yes ❑ No 2' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200'feet.) w <br /> Septic nk: Distance from nearest welt-___---_-_Distance.from-foundation_/P__'e`-_._:-_-.M ------- <br /> aferial- - - --- ----+ -------------------- <br /> .---.-__-__ . <br /> No. of compartments___­_p----------------Size-�---- - s ._--Liquid depth------ -t------------Capacity---4_!? <br /> I <br /> Disposal Field: Distance from neae stwell....._`..-__--Dis9nce from foundation-- ---- <br /> -- ------------Distance to nearest lot line---0--__----- <br /> i - <br /> LJJ Number of lines---- ----- -------------------Length of each line---9'0_f___-----.-_.._--.Width of trench--_-Z_.l`(---___._____._______._ <br /> Type:of filter material___/�O_.............Depth of fil#er rho#erial-7:8_.--------------Total length--------- P-'------__-_______--_-.- <br /> i _ <br /> Seepage Pit: Distance fo nearest}well__r_�_`:_______Distance m f0yndation__�4_______.___.Distance to nearest lot line--. ----/_-_-_ <br /> Number of pits...-_[...............Lining materiaf_'_:_/�Q !�-_..Size: Diameter.-_Z3-T <br /> ___...._.Depth_..__2c� D <br /> Cesspool: Distance from nearest well-_-_-.______--_Distance from foundation_----_- --_ Lining material------------------------------------- <br /> ❑ Size: Diameter----------------- ------ --- ------Depth------------------------------------------------------Liquid Capacity- --------------------- ----gals. <br /> Privy: Distance from nearest,weft--- <br /> -- ------------------------------------------- .-Distance from nearest building----------------------------..------------- <br /> ❑ Distance to nearest lot line------------------------------------ + <br />' Remodeling and/or repairing (describe):--•.------•--------------------- --- --------------- --=-------------------------- ---------------------------------•-------------------------------- Is <br /> : - - ---------------------------------- <br /> -----------------------------------------------------------------------------------------------•----------•---------------------------•----------•------------------------------------•------------------------------------ <br /> I hereby certify f t I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> I ordinances, State la a les gula ons of the San Joaquin Local Health District. <br /> (Signed) c---- ----- -------------- --- -- --------------- - ----------------------------------------------------------------------------------(Owner and/or Contractor) <br /> a By:----------------------------------- - ------ -----------------(Title)--------- ---------------------------- ....... ------------- - <br /> -- ------------------------------------------------------ <br /> (Plot plan, shawing...sizw:of lot, location of system in relation to, wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------•---- AttIc <br /> %' -- -... _ <br /> -•--- DATE---7--- r <br /> -rV-- _k i------ ------- <br /> REVIEWED BY------------------------------------------ ------ DATE----------- <br /> BUILDING PERMIT ISSUED-----.---------------------------- ----------------------------------------------------------------- DATE----- <br /> Alterations and/gr reco m da ions:------------ --- --- - ------- --------------------------------------------------------- -------------------------- - ------ ------------------ <br /> FINAL INSPECTION BY:. --- . - ------------- Date -1-`1 ' ---------------------------------------------- <br /> S JUIN LOCAL HEALTH DISTRICT <br /> Q <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />