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FOR OFFICE US�: ------------ <br /> ` _5d APPLICATION. FOR SANITATION PERMIT Permit No. 4�.... <br /> ........... - �'- ----- -� : <br /> ----'----------------------.--- ---- (Complete-in Duplicate) <br /> Date Issued . _._-�`...... <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 LOCATION__._. / �, T - - �1------------------------------------------------------- --- --- I <br /> I3[_- r <br /> Owner's Name------------� ---- Ir x ---------------- ----------------- --------- - Phone i <br /> Address-_ 4�. •-- t----- �— ---------------------------------------------------------------- -------------------------------------------- <br /> __-------------- ------------------------------------------------------------------- --- --- <br /> Contractor's Name------..-..---- -. c-:•fe [ '��= -r [• - Phone Z!1 t <br /> Installation will serve: Residence Apartment..House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ 'Other ❑ <br /> Number of living units: __�____ Number of ,bedrooms _�..__. Number of baths _-I--_- Lot size ----- --- ------------­----------.---_._-_--.--_-.--._.-_ <br /> Water Supply: Public systemCommunity system [I private-E]—Depth to Water Table ------ - ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: Ilf yes,dote-_.--_-.._- No X- New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer-is avadable_within 200 feet.) <br /> Septic Tank: Distance from nearest wek-----------_..._Distance from foundation...................Material ______.-.._----._-----____----_---___-.._._..-. <br /> ❑ No. of compartments-..- --------- ------ ---Size-------------=------ -----------Liquid depth--------- ------- --- ---Capacity-----=---------------- <br /> Disposal Field: Distance from nearest well-.-._'.-.- _Distance from foundation-------------------Distance to neares -lot.line----------------- <br /> Number of lines.----:-- _--- Length'of~each line__.. Q-_-________------Width of trench.- <br /> ---------- <br /> Type of filter material-- .--..__.Depth of filter material----JA_........ Total length.......44-C,----------------------eC� � \\n <br /> See pag Pit: Distance to nearest well----------- Distance rom foundation--------------------Distance to nearest lot line.... <br /> :umber of pits.-- -/-------- g - iI. ....Depth-------U-- -------- <br /> ___._.Linin matenal._ ._ - :- Size: Diameter-___._ ----- (.4- <br /> Cesspool: Distance from nearest well ------ ------—Distance from foundation_-.._._____------ -Liquid Capacity----------- --.._-_-._-_-_gals. I <br /> Size: Diameter- -- ------------- --- -----------Dept h--------------- --------------------------- <br />' Privy: Distance from nearest well-------------------_. _--.._---- -------------Distance from nearest building.--_--_---4---.__.__._------.--- <br />` ❑ Distance to nearest lot line .--- -------- ------------------ ------------------- -------------------------------------------------- - <br /> ------------------ ------ <br /> Remodelin and/ r re airrng {descnbe):__._. � -�- <br /> 1GcLt�.t--------------------------- <br /> i <br /> ----- - ;-- � ------ ---------------•------------------------=--- ----------•--•---------------- ------------------------------------------------------------- <br /> hereby certify that I have prepared thisapplication and that the work will be done in accordance with San Joaquin County <br /> l ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> f r -----___.-_._ Owner and/or Contractor <br /> Q� ( ) <br /> (Signed} I �reverse <br /> A - <br /> F - ------ {Tile) <br /> (Plot plan, sho g size of loft, location of,syste_m in r atioin to wells,-buildings, etc., can be placeide). <br /> RTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------- - - - - -- - --- ------ - - ------------------------- <br /> DATE Aly�6 ----------- <br /> REVIEWED BY DATE------------- -------------------------------------- <br /> BUILDING PERMIT ISSUED-------- -- ---- ...... --- ---- -�----- - - - DATE - <br /> Alterations and/or recommendations------------------ ----------------------- -- ---{ -------- - -- --------------------------- ----------------------- --------- <br /> - � <br /> k .................................... ............_-._.-----_-.----..-...._.--_--- .--. ---- <br /> I r <br /> FINAL INSPECTION BY:- --------- Date........ '. --- ------ -. ----- ---------------- ---------- <br /> SA JOA UIN LOCAL HEALTH DISTRICT <br /> 1601 E.Nacelton Ave. 300 Wast Oak street 124 Sycamore Street 205 Wast 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press `` <br />