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FOR OFFICE USE: <br /> ----------------- <br /> Permit Na ------- <br /> / <br /> - -- APPLICATION FOR SANITATION PERMIT <br /> --------------------gl'155 I — <br /> ------------------------ (Complete in Duplicate) Date Issued1_` 5__--- <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 No. 549. <br /> JOB ADDRESS AND LOCATIOK___-``/_Q----�----- �--di.....-L'. --------------------------------- --------------------•---`---------- <br /> Owner's Name----------------•----- J10--�_,-_i2'----•--- 51' _f,7-c -4- L � .�� ---------- ------- <br /> Address-----------------------------­-------/a.... .......... ------S" <br /> Contractor's Name / i -,/-S-�---��Y�-&----------------------------------- -------------- <br /> Phon❑e--��. <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court Motel Other <br /> El <br /> Number of living units: __/_ Number of bedrooms __-'L- Number of baths _1___ Lot size ---p��,�-----V-57'---- ---`----- <br /> Water Supply: Public system [jp/Community system ❑ Private ❑ Depth to Water Table _ ------ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E+-Clay ❑ Adobe ❑ Hardpan ❑ <br /> 1 <br /> Previous Application Made: {If yes,date--------_..........) No [4---New Construction: Yes E] No E4--fHANA: Yes E] No [j� <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 wel!_________________Distance from foundation--------------------Material----------------------- ______-___..______---_. <br /> ❑ No. of compartments Size -------------------Liquid depth----------------- ------..Capacity---------- -------- <br /> Disposal Field: Distance from nearest well____..~-~_..._Distance from foundation__�g.._......Distance to nearest lot line/ ------- <br /> Number of lines----- /�----------------------Length of'each line-__.-2-1 ----------- i--._.Width of trench------ .--------------------- <br /> Type of filter material----/4*4-- . p <br /> De th of filter material ___/� dotal length_____ 9.c9_"__------------------------ <br /> Seepage Pit: Distance to nearest well------ __._Di€stance fr m foundation___ Q_`__.Distance to nearest lot .---- <br /> Number of pits----------1.._____Lining material__�__ /t�5ize: Diameter"_____ __ ______Depth------- <br /> 5------ -- <br /> I Cesspool: Distance from nearest well________-.._____Distance from foundation--------------------Lining material---------------------- -------------- <br /> El <br /> ________-❑ Size: Diameter-------------------- . --Depth- ------Liquid Capacity----------------------------gals. N <br /> Privy: Distance from nearest well ___________________-------------_---------------Distance from nearest building----- ._______.________--_____..__._---- <br /> ❑ Distance to nearest lot lire.-------------------- -----------""" >� <br /> t _/ r <br /> Remodeling and/or repairing �descriUe]:------------ �f__ �--------- __/9S_ 'lK ----- !' <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 County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> Signed1`-'l/T —- -'r------------------ ---------------- --------(Owner nd/or Contractor) <br /> ( )----------------------------- - - - / <br /> Sy:------------------- �s- - ------ ----------------------"----------(Title)----- I--------- --------- <br /> i (Plot plan, showing size of ot, location of system; in relation to wells, buildings, etc., can be placed on reverse side. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------- _- ----------------------------------- DATE---------- - -- �5--------------------------- <br /> REVIEWED BY----------------------------------------- - -- ------------------------- ------ ----------------- <br /> ------------------------------ DATE-------- -------------------------------------------------- <br /> - - - - <br /> BUILDING PERMIT ISSUED------------------------------------------- _ D TE.-_----------- ----- <br /> ----------------------------------------------------------------- <br /> Alterations and/or recommendations:_'_,_ S ---- -- �����-�----�=�- '----- � ------------- <br /> ' _ --------- -------------------------------------•-------------- <br /> —C—C _ �til !'� �. <br /> .. . L ----- ----•-------------------- <br /> } -•-- ----------------------------------• ----------------- <br /> �/� <br /> - ---- ...._ ---- <br /> FINAL INSPECTION BY: -------- •---------- ------------ ----------------- Date-- ---- ------. ------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <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 /> F.P.CO. <br />