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FOR OFFICE USE: r <br /> 3 t <br /> 7-----------------3 �7 <br /> - ------------------ ----- ----------------------- <br /> �APPLICLkTION FOR'SANITATION PERMIT <br /> Permit No. <br /> ---------------- ----- --------- (Complete,in Duplicate) `` <br /> Date Issued <br /> - ----------------------- ----------------------------- --- This Permit Expires 1 Year From Date Issued i <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 LOCATION ------t - :..-.... _ i <br /> Owner's Name 7:=._.�' 7 �1-S'0�---••------------------------------ ------ ---------------------------------------------- Phone a <br /> Address-------------------------z . . - ---------Q1�-------------------------------------------------- -•----- - -------•--•----------- <br /> Contractor's Name Phone.:-F?`Tll/f� O1f <br /> Installation will serve: Residence [E­A_"artment House ❑ Commercials❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __ --- Number of bedrooms _2� umber of baths__1... Lot size .- �-`�- �`.....-1_.?�C�..- <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table .-_ -_ - ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [1}—ft6r-dpan ❑ <br /> Previous Application Made: (If yes,date................... } No ❑ New Construction: Yes ❑ No HA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> r <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> is T Distance from nearest well.................Distance from foundation------------------- Material ----------------------- ----------.----.-....... <br /> ~� No. of compartments------------- ------- ----Size-------------------- -----------Liquid depth--------- ------- --------Capacity------------- -------- <br /> D- osayI R Id: Distance from nearest weII Q1...Distance from foundation----- _f....Distance to nearest lot <br /> Number of lines.----� -- g f!---- --- --------- <br /> Pl� <br /> -.._-Length of each line__ ___ -.QQ...'.-.___..Width of trench. �__. <br /> Type of filter material��.t:. -._Depth of filter material... Total length...._-.._-._-......./�J '------ <br /> 49xDistance-to nearest well----------------------Distance from foundation_._..............Distance to nearest lot line----------------- <br /> <mber of pits-----------------------Lining material--------- - Size: Diameter----------------------Depth-------.------------------------- <br /> Cesspool: Distance from nearest well ----------------Distance from foundation----------------- --Lining material.............. ....----------.---.-. <br /> ICA <br /> ❑ Size: Diameter- _. --------- ----- ----- --Depth--------.------------------------------------------ Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well_-- - ------------------------- ........ .Distance from nearest building--......---.._...--_.--_.------.--_..: <br /> ❑ Distance to nearest lot line-------- ---- --- --- -------------------------------------------------------- ------ ------- --------- ------------------------------- <br /> . Q <br /> Remodeling and/or repairing (describe):_------------------------ -- ---------_---- _.._......-.. .-. <br /> ---- •---------------- :__xggef :.:____:__:___::______:__:___:__:_:_::____:__:_-::-- <br /> -------- --------------------------------------------- --------------------------------_-------------------------------------.----------.------------------------------ ------------------------------------------------- <br /> I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County. <br /> ordinances, State I ws, and rules and regulations of the San Joaqui Local Health District. <br /> f 1 <br /> (Signedf-�- 'v----�-- )L --•----------------------------- -.{Q'"*ter /o�,Contractor) <br /> By:------------------ ---------------------------------------------------------- - ------(Title)--------------- - - ------ - - - <br /> (Plot plan, showing size of lot, location of system in relation to w , buildings, et ., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- -- - = �' ----------------------- DATE-- �--�-�--�------------ - <br /> REVIEWEDBY---------------------------------- - _------------- - ---- - ------------------------------------------------------ DATE------------------ ----------------------- -------------- <br /> BUILDINGPERMIT ISSUED ------- -- ----------------------------------------------------------------------------------------- DATE - ---------------------- ------------------------- <br /> Alterations and/or recommendations:..... ......... ........ -_t--- <br /> ----------- ------- - - --------------------------� --------- ----------------- ------- --- -------------------------•-----------------= <br /> --------------------------------------------------------------- ----------- <br /> --•-- -----------------------------------------.-. ---------------- -------- ------------------------------------------- <br /> ---------- - -- ------ - .............................. ----r-- -------------- ----------------------- --------- -------- -----r - - ----- ---- - -- -- ------------ <br /> FINAL INSPECTION BY:-..-�.._�7. .------ Cit------------------ Date..:.../ -6. L!_9 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 91h Street <br /> 5lockton,California Lodi. California Mantecar California Tracy, California <br /> E.H.9 2M 1.67 Vanguard Press <br />