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FOR OFFICiEE USE: { <br /> -------- <br /> -____ � �`�- ---q-�I APPLICATION FOR SANITATION PERMIT Permit No. ......../...-.��. <br /> -- --------- <br /> ----------- (Complete in Duplicate) <br /> ------------ - _---- This Permit Expires 1 Year From Date Issued Date Issued .. ..... ___-.- <br /> Application is hereby made to the San Joaquin Local Heal}h 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 LOCAT N.- . --------�- --------- -� ------....--------------------------------------------------------•-•--------- <br /> ----- -...._. <br /> Owner's Name............. W_=�=�----....----/ s?- - l r' F ------•-------------------------•----.. Phone., �.x.73 <br /> • - 4ts 1 �� <br /> Address �' +-^ t <br /> ...............................--_-----------------------------------------••--•----- ; <br /> Contractor's Name----------r f Phone. <br /> Installation will serve: Residence'®' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Q Other ❑ <br /> Number of living units:/--- Number of bedrooms ___- Number of baths__-_ Lot size -_----------------_-----_--.__-� ' ............:.. <br /> ' . _ ' <br /> Water Supply: Public system JKL, Community system ❑ Private ❑ Depth to Water Table Zit" ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam$ Clay Loam ❑ Clay ❑ Adobe,0 Hardpan ❑ <br /> Previous Application Made: (If yes,date-------------_-----). No R' New Construction: Yes ❑ No [ HA/VA: Yes ❑ No- <br /> y <br /> r TYPE OF INSTALLATION AND SPECIFICATIONS: 1 <br /> (NoTank: Distance from nearest well-J'-�,t _Distance fromwithin 2 n feet.) <br /> septic tank or cesspool permitted if public sewer is available <br /> 'Septic ' -- from foundation---.1-�!..._____.Material-----t�� rl <br /> � No. of compartments------`�..------------- /: --.Liquid depth-------�f---------------Capacity-_• ---"--�-_-•• <br /> Disposal Field: Distance from ,nearest well-- �52,,10istancelom.foundatian:...f :: .:Distance,to nearest lot line___-- <br /> ne <br /> Number of lines <br /> _Le gfachhinter--------'_-- ....` !idth of trench---------•_Ly---....�of length--------- ----------.-.-�.-.-...-.-Type of filter material..----� ph off <br /> 1 . <br /> N mber of Its----_--1-------------Linin material---- -. Size: Diameter--- ' <br /> ---- !7m — <br /> � stance o nearest lot line--- <br /> Seepage Pit: Distance toPearest�well-----�--�'-'.--Distance <br /> 9 Distance fou dation___.--� .__ Di t ,t f� ,Depth � � � <br /> / l4 <br /> , u <br /> Cesspool: Distance fromrnearest well-----------------Distance from foundation-.--._ 7------.--Llniing aterial---- -------------_--------------- <br /> Size: <br /> ---- ----------------- <br /> Size: Diameter=--------- -------------------------Depth-------•------ •---------------;--------- `' --Liquid Capacity----------_--------_-...gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-_'i---------------------­­--------_. <br /> ❑ Distance to nearest lot line----------------------------------------------- ---------- ................•-,----------------------------------------------------.---------- <br /> Remodeling and/or repairing (doscribe):!--- - ---- -------------------------•--•-•---------• -------- <br /> e <br /> i l <br /> --- a -- -----•------ = <br /> -------------•------- '---------••-;-----------_--.----•--------------------------- <br /> _______ i ,-,"i"------ ---.4--------------------------•----- ------------- <br /> I hereby certify that I have prepared this application and that the work will 13e done-inaccordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin.Local Health District. <br /> l -------------------------------------------------------------------(Owner and/or Contractor) <br /> (Signed)- - t 3 <br /> By:---- � - . ....(rile) <br /> (Plot plan, showing siztlot, locatio of systerrort to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY �'�i =-------------------------- DATE-------------- <br /> ----------� 1-7- �-... <br /> REVIEWEDBY------------------------------------------------------------------------------------- ------'----------------------------- DATE--------..--•--------_-------------------------------------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE----------------------------------------------------------- <br /> Al4era •ons a /or recommendations:-------------- ------------------------ ------------------------ .........................-----------------------------------------------------•------ <br /> _ - -- ---- --- -------Q `-- <br /> -> c2 --Jr-------- -_. <br /> 'J- <br /> - <br /> ------x1r Wit• , '� s <br /> ��/LB Gv►lC.l s ,c 2� L�Ems/ <br /> 7 _1 <br /> GF i P <br /> FINALINSPECTION BY--------- ---------------- �------ - ---- ------ ,p Date----- ------------- -------------- --------------- ---------------------------- <br /> If <br /> l �•--- SAFN JOAQUIN LOCAL HEALTH DISTRICT <br /> 13 Sout American street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> f tockton,California Lodi,Cay�llifornia Manteca,California �[)1 �/- Tracy,California <br /> ES 9 REVI EO 819 2M 5-61 ATLA�� �N�[�T✓, �✓t�-'�s-Q�� (� � .-6..t« a(�J l Y.f t - [_r <br />