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FOR OFFICE USE: <br /> '-.__y._- - �_----_---_.-.---- - .--.. APPLICATION .FOR SANITIATION PERMIT Permi# No. <br /> ------:---------------------------------------------- (Comple+e•in Duplicate) �i t <br /> - _---_._ _ ." . _ .._.. ;. This Permit Expires 1 Year From Date Issued Date issued <br /> Application is hereby made to the San Joaquin Local Health Dist ict for a permit to coristruct and install the work herein described. <br /> This application is made in compliance with County Ordinance o. 549. <br /> c <br /> JOB ADDRESS AND OCATION -- -------------------------------------------------- <br /> 4- ------- <br /> Owner's Name____ Phone* 3_.-'_7 4 <br /> ---- <br /> Address ' __ -------------------- rrr�, <br /> w A <br /> Contractor's Na a---- ----------------- - 2-�a----------------- Phone..�f'-&- - -P -- <br /> Installation will serve: esidence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: --I__._ Number of bedrooms _7,—Number,of baths.__1---- Lot size ____ ----____--__-.--.__ <br /> Water Supply: Public system D�L Community system ❑ Private ❑ Depth to Water Table,7S�ft <br /> Character of soil to a depth of 3 feet-': Sand ❑ Graver❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ l <br /> Previous Application Made: (If yes,dote_- ----------- J No New Construction. Yes ❑ NoK FHA/VA: Yes ❑ No4 v' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: i I <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 /> ❑i KASY'l No. of compartments---------------= _Size. Liquid d`pth--- CapacitY �`r - <br /> Disposal Field: Distance from nearest weli.klN.a_Distance from foundat-oonQ_ --------Distance to nearest lot line- j <br /> Number of lines ------_Length of each line._6.0--�--+- _,F-._.Width of trench- Z� ._._ s <br /> Type of filter material_ . . -_. ....'Depth of filter material../--%__ _________Total length____-&A2--------------------------- <br /> Seepage <br /> A2--------------------------- <br /> Seepage Pit: Distance to nearest well......_1-_----.._._'Distance from foundation____________________Distance to nearest lot line_-------.._--.. p <br /> ❑ Number of pits--- ------ -------Lining material---------------------- Size: Diameter-----------------------Depth--------------------------------- <br /> Ci <br /> Cesspool: Distance from nearest well ___._-:___-:.__Distance from foundation................. ..Lining material------------------------------------- ` <br /> [� ------ --:' .......--..Depth '' Liquid Capacity-... gals. <br /> Size: Diameter- .. -_ <br /> Privy: Distance from nearrest_we€I----I----..-..-. -..__.__--- °*:_._"...Distance from-'knearest building-------------------------------------------- <br /> ❑ Distance to �nearestdo-f line,_-.. - �t <br /> .� r - --------------------------------- - - ------------------ ------ <br /> Remodeling and/or repairing (descrrbe�: .' ----------- -- =-------------------------- <br /> �; T <br /> I'I � �` <br /> ---------------------•------------------ ------------ - --------- •------------------ -- --- <br /> --------•--------•------------------------------------------ _ <br /> ------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------ —............----------- <br /> I hereby certify that-I h e prepared this application and that the rk will be done in accordance with San Joaquin County <br /> ordinances, State laws, and ul and regulatio' of the S n Joaqui cal Health District. <br /> J` <br /> (Signed)------------------- -------- -- -- - ------ -- ----- - -- ----- --. -- ------------------(Owner and/or Contractor) <br /> --- - <br /> ' Title <br /> (Piot plan, showing size of to , location of system in relation to wells, buildings, etc., can be plali d on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---{--= -- .:I -'---------------------------==------- DATE-- ___F-7Z- <br /> REVIEWED <br /> F---Z. <br /> REVIEWEDBY------------ --------------------------------- - --------- - -------- ---- ------- ----- - -- ------------------------._DATE-`.---- ----- - <br /> BUILDING PERMIT ISSUED-------- -- ------------------------------- ----------- ----------- --------- -- --- ----- DATE--,-------- ----------------------- --- -------------- <br /> Alterations and/or recommendations:_- ,�=_3_-_��_.___- h-��. 'F�- . _____�_ <br /> ------------------------------ ---- -- ------------------ ------ °-. -------- -- ---------- ----- -- --- <br />¢ ---------- -----------------•------------- --------- ---------- ----- <br /> --------------------I---------------------------------­­................. -------------------------------- --' ------ <br /> FINAL INSPECTION BY:..----- -- .......... Date------------------- �-----------.-------------- <br /> 4 SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Mazellon Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> E E.H.9 2M 1.67 Vonguprd Press <br /> F <br /> f ^� <br />