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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT Permit No. . _- <br /> lQ -"= '------- --------- (Complete in Duplicate) <br /> ----------------------------------------- ......... This Permit Expires 1 Year From Date Issued <br /> Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and insta4l the work herein described. <br /> This application is made in compliance withCountyOrdinance No. +549. <br /> JOB ADDRESS AND La TION-------------/ __ eJ:�t-?Z n 51�- <br /> Owner's Name------------- fy_� ;�L..L I- -',e" Phone <br /> Address ------,.---- <br /> Contractor's Name------ ---- -------------- c <br /> ^v Phone f <br /> Installation will serve: Residencepartment House ❑ Commercial ❑ Trailer Court [❑ Motel ❑ Other ❑ j <br /> ■ , t. 1 <br /> Number of living units: -_T Number of bedrooms _A�_ Numberraf,-baths._/:-_.Lot size _______________________________________________.____-._-_-_ <br /> Water Supply: Public systemommunity system ❑ Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy foam E❑ Clay Loam ❑ Clay ❑ Adobeardpan p <br /> Previous Application 1 Made: (If yes,date-------_------- ----1 No W-"New, Construction: Yes ❑ No FHA/VA: Yes ❑ No� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: %�r <br /> (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) 4 <br /> Septic Tank: Distance from nearest well_________________Distance from foundation------------------- Material______________.�____-._.._--__._____-._________. <br /> of compartments---------- --------------Size--------------- ----------- ---Liquid depth------------- t Capacity <br /> ' .' t i 4 i <br /> .�-_ __.Distance 'to nearest lot line___ ___________ <br /> ,l__-__ Length of ea� foundation-_� - y�"' <br /> is osa ie Distance p tante rom nearest well_.-.�"'"_ '\1 Number of lines--------- -_ Distance from h line____ rJr <br /> k g ry Width of trench.-0--------------------------- <br /> 3­1 <br /> / 5/ / T e`of filter material_ <br /> yo .-._._Depth of filter material___ -__,__-.Total length-__-,_ _. <br /> Seepage it: D.istaiice to nearest well-.-_-- ------Distance fr foun ation___ A_____.Distance to nearest lot line______-._ <br /> .: Ll[r� Number of pits. r------------Lining material- �C Size: Diameter_- �`-____Depth_t _�______________-_ <br /> Cesspool: Distance from nearest-well------------ -_Distance from foundation-____.__----- ------Lining material_____________________________-__- <br /> ❑ SizelMD:iameter---------- ...... ---- Depth(--- ----------------------------- --------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well---------------------------------- ---..Distance from nearest building-----.-_.__----_-____-____.-_____-._____. <br /> ❑ Distance to nearest lot line------------------ -- s <br /> � f <br /> Remodeling and/or repairing (describe) __------_---- - G�'�/�!azz ^''' 1 <br /> ------------------------------ ------------------------------- ------------------------------------------------------------------------------------------'-------------___-v---- -------------- F <br /> -------------------- <br /> Ir <br /> - ------------------- ----------------------------- ------------------------------------------------------------------------------------------------------------------------------------------=----------- Y <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count <br /> ordinances, State laws, and rul 17d regulations of the San Joaquin Local Health District. <br /> (Signed)------ --- (Owner and/or Contractor) <br /> BY _:: - k ------------------ ------------ Title --------- <br /> -------- <br /> -------�..11(1.Q c <br /> (Plot plan, showing size of t ocation of system in,relati� wells, buildings, etc., can be placed on reverse side). <br /> t. FOR DEPARTMENT USE ONLY r <br /> APPLICATION ACCEPTED BY_________________ _ _____.__._ #• <br /> ---'-- --------------------------------------- DATE--------- <br /> REVIEWEDBY----- -------------------------------- -- - - - ----------- -..... ------------ ---- - ------------------------:_ DATE -= <br /> BUILDING PERMIT ISSUED -----------{ <br /> Alterations and/or recommendations:----- -_CS G.-�y .. - --- <br /> J <br /> ------------------------------------------------------------ C71 -- ------- - - <br /> ------------------ -- --- ---------------------- ------- ------------------------------ ------ - -------------------------------------=----------------------------------•--------------------- ------------------------ <br /> FINAL INSPECTION BY:- - -- --- --------- ------- - --- ---------- Date_---- - -- <br /> SAN <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT , <br /> 1601 E.Naxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California E Tracy,California <br /> F.P.r.O. J! <br /> f <br />