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FOR bONCE USE: <br /> ----------- <br /> ------ - - ---------------I __ /v------- <br /> �APLICATION FOR SANITATION PERMIT Permit No. Za�...... <br /> -- <br /> ----------------------- --------------------------------- (Complete in Duplicate)• Date Issued <br /> ---------------------------------------- I This Permit Expires I 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 AT OKwitYh County Ordinance No. 549. <br /> JOB ADDRESS AND 1 0 <br /> �LCC ....J��_ .... .. .......---------------------------------------------------- --------------------------------------------- <br /> - <br /> -433 <br /> Owner's Name-------- _:7...................... ----------------------- -------------------- -------. Phone------------------------------------ <br /> Address----1-1: ...... ---------- ------------------------------------ <br /> /o --- -----------------------------------------------------------------------.......................... <br /> -- <br /> Contractor's Name---- --- ------------ ------------------------------------------------------------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence E!rApartment House [] Commercial [-] Trailer Court Ej Motel F] Other [I <br /> Number of living units: --/-- Number of bedrooms A.. Number of baths J--- Lot size It---al"On >_________________________.__ <br /> Water Supply: Public system E] Community system El Private 2?15epth to Water Table"-- t. <br /> - <br /> Character of soil to a depth of 3 feet: Sand ] Gravel [ Sandy Loam EClay Loam Clay <br /> Adobe 9Y00"Hardpan F <br /> Previous Application Made: (if yes,date----------- --------) No [?TONew Construction: Yes E] No 23-`FHA/VA: Yes 0 No ®-- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> A�fwf <br /> tic-Tank; Distance from nearest well-----------------Distance from foundation--------------------Material------------------------------------------------- <br /> No. of compartments---------------------- Size--------------------------------Liquid clep�h-------------------------Capacity----------------------- <br /> Disposal Field: Distance from nearest well----!e�. _ Distance from founclation-&--/......Distance to nearest lot lineA_P__ <br /> Number of lines_________ --Length of each line__"_77_�----- ---------Width of trench_ ----------------------- <br /> Type of filter materialljf.21?04�__Depth of filter material--- --------Total length---- ----------------------- <br /> Seepage Pit: Distance to nearest well__/,0?_40_`__Distance from foundation---Adk"e../_Diiiita 00 <br /> uce to nearest lot line/V------------ -- <br /> Number of pits.__. _____-.__._-Lining material._/_efgr*40,7__Size: Diam0er-_."_:--------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation---__.-------------Lining material------------------------------------- <br /> 171 Size: Diameter--------------------------------------Depth------ ---------------------------------------------Liquid Capacity---------------------------gals. <br /> gals. <br /> Privy: Distance from nearest well-------------------------------__---------- ---Distance from nearest building___--___.-----_............ ........­ _P <br /> 171 Distance to nearest lot line----- -- ------------------ -------------- ---------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):--._--..-__--4W---01t4o.7-4 ---------­--------- -------------------------------------------------- <br /> -----------------------------------------------------------------------------------------------------------------------------------O-r---------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------- --------------------------------------------- <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 pules and regulafigps of the San Joaquin Local Health District. <br /> ) 92, of <br /> (Signed -- --- ------------ ------------------------------------- <br /> - <br /> By:------------------------------------------------------------------- ---- -----------A,; -------(Title) ------------ ---- --------- <br /> ion to wells,-------9-- <br /> (Plot plan, showing size of lot, location of system in el ion to wells, buildings, etc., can be placed on reverse side). <br /> 6� <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------------- --------------------------------- ---------------------------------------- DATE------4--J-7-4-4-------------------------- <br /> REVIEWEDBY------------------------------------------- - ­ --------- -------------- ------------------------------------- DATE----------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE----------------------------------------------------------- <br /> Alterations and/or recornd <br /> Tenti a ions:---- ------------------- -------------- -------------------------------------------------------------------------------------- --------------------- <br /> ------------- _r-- -- ----------------------­-------------------------------------------------------------------------------------- <br /> -------------- -----------------------------------------------------------------------------------------------------------------------------------­­----------I----------------------------------- - <br /> ---------------- <br /> ------------------------- --------------- -------- ------------­------------------------I-------------------- ----------------------------- ------------------------------------------------------------------------­ <br /> ----------------------------- -------------------------C---/----------------- ---------------- -------------- --------------------------------------------- ------------_-r--_--- <br /> ----------------- -------------------------- <br /> FINAL INSPECTION BY: . ------------------------------------------ Date- '? - __-4 -------I------------------------------------ <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 /> F.P.V0. <br />