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11 FOROFFICE USE: <br /> ------------- ---- -- - ------------------------ <br /> ...__.. _.Il.._..__ __ ___ --------- - APPLICATION FOR SANITATION PERMIT Permit No. .,V-2KD.7 <br /> - <br /> ...._..._ ,1I11. -- --- ---- --- --------------------------- (Complete-in Duplicate) .� <br /> ._.-.._._ -.__ _ '._.__- This Permit Expires 1 Year From Date Issued Date Issued _f...1_.�� _:_�� <br /> —Zo 10•-02 <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install he work herein described. <br /> This application is made in compliance with County Ordinance No. 549. E .S,` <br /> 2.2.j—t z <br /> ,013 ADDRESS AND LOCA TION ...... <br /> At_ <br /> � 1 <br /> Owner's Name !. f �" - ---•-------- ........ . ---------------------------- ---- - Phone--- ,7 <br /> Addressl.1/­ / - /�C --------- �-�_--------•-------------------------••---••-- <br /> G�ntractor's Name------ � a - - .... 1,&P �-q_�---------------- 1 / � '� /Phone.._1�``3_ _w <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑. Other ❑ <br /> Number of living units: __ LNumber of bedrooms 3___ Number of baths___!-__ Lot size .-_._ __ _ ____ __ ________________________________, <br /> Water Supply: Public system ❑ Community system I] Private �Depth to Water Table _-ra ft ' <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hard'pan in <br /> Pr vious Application Made:; (If yes date_....-__.__.__--_-_ J No,jR'New Construction: Yes No ❑ FHA/VA: Yes ❑ No;!�` _ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> ti. ..., �(No.septiefank-.orcesspool_perxnitted_ifpublicewer_is.=available within-200 feet.) <br /> Septic Tank: Distance from nearest well---- Distance from <br /> _ _ <br /> foundation____f_61__�__.Mate�ri-al -------clex- `. ._---.-._-___-'-----. <br /> No. of compartments____-_.-� _ _. Size __�-d'k!`_1d__Liquid depth------- <br /> � <br /> r_ -__---.-Capacity.__�_���_�. <br /> Disposal.Fielcl: Distance from nearest w•eIell_--�_---_Distance from foundation___._1_a_/�--_-Distance to nearest lot line__ <br /> Number,of lines__________ � �_--� Length of each line__.-----�_A_.-.__��-_--.Width of trench------- -- `------------- <br /> Type <br /> -----. <br /> T e of filter material____/l - Tota! length <br /> ! YP `a O- -----Depth of filter material--- ---��-....---p --------��-Q-�- -----------�---- <br /> Distance to near st well. ...........Distance from foundation____- -__=_!_.Distance to nearest lot line__.s <br /> Number of . ..__- -----__Lining material. _ _ < ._. Sze: Diameter._.___ 1P.f-_Dept h---- <br /> _ <br /> Cesspool: Distance from nearest well ----- ---------Distance from foundation.............---- _.Lining material--------.._----- ._..___-_____ <br /> j� ❑ Size: Diameter- - ----- ---------------Depth- --------- --------------------- -- - -------Liquid Capacity - -------------------------gals., <br /> Privy: Distance from nearest well-----__-----------------------------------------Distance from nearest building--------------------..________-_....._ <br /> ❑ Distance to nearest lot line - ------- ------- ------- ` <br /> k <br /> ii <br /> Remodeling and/or repairing (describe):----- - -----• ------------- --- ---------------------------=------------ ----------------------------------------- ---------------- - - ------ <br /> l (� ---------------•---• ------------------ <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)_ ---- -- ----- - - --- ------------------ ---- ----- (Owner and/or Contract <br /> --------- ----- --- --- -- - - --- <br /> Y�= _ ---------------- <br /> - or <br /> ............� ----- <br /> (Pht plan, showing size o lot, location of system in relati n to wells, buildings, etc., can be placed on reverse side). <br /> i <br /> ��. FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED,8Y---------- DATE Wil/ C <br /> ( BlJILDING PERMIT ISSUED' _...�,----- <br /> -------------------------------- ----------- ----------- - - DATE---- ------------------ -------- ----- -•--------------- <br /> a -- s:--------- -- ---- ----------- ----- <br /> L!��� DATE - <br /> - --Alterations - <br /> Alterations and/or recomme <br /> ------ --•------ ---------------- ------ . <br /> ----- ---------------------------------------- ---------------- <br /> ---------------------------------------- <br /> ----=---------------- ------- <br /> --------------------------------------------- <br /> - --------- <br /> - ---------------------------------- ........ ---------------- ----- ---------•------- <br /> INAL INSPECTION BY:.. <br /> ,;,r_- __- ----- 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 /> E.H.9 2M 1-67 Vangaard Press <br />