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r FOR OFFICE USE: �y <br /> - - <br /> ....... .................. _..._. .......----• <br /> .............................................. .......... APPLICATION FOR SANITATION PERMIT tt�1'' Permit No. _ _. . / <br /> .......................•---•--.-- -- ................... (Complete in Duplicate( ✓r- Date Issued ....?lJ <br /> ..... ............................................... This Permit Expires 1 Year From Date Issued Y <br /> ��pplica+ionis hereby made to the Sen Joaquin Local Health District for a permit to construct and in all the work herein described. <br /> This application is made in compliance with County per' ante No. S49. A�Oej bl'w t <br /> fap r E . 6f krc F .2 :D <br /> JOB ADDRESS ANION..... - `. ._... . .....4?X... .��RZS...S7. Tilt''ti..:'......_mX' ''t. l�eS.. : -- <br /> Owner's Name__....... ....... .`. ----.._..._-._....-----...... Phone � s3�P�+ <br /> Address.—_...............40ZGwcv ...-- <br /> Contractor s Name-----..... ¢.<G�aL..�. J C�+....................... ..•---......... Phone...I--d� <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Ej Other ❑ <br /> Number of living units: ...[. Number of bedrooms_..arc. Number of baths ...L Lot size ..... ................. <br /> Water Supply: Public system ❑ Community system ❑ Private [a]/bepth to Water Table fs.F. ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam Clay❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date....................) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION_AND,SPECIFICATIONS: - <br /> �.�- — .. <br /> (No septic tank or cesspool permitted if public 7wer is available—within 200 feet.)., <br /> Se tic T Distance from nearest well.�....Distance from foundation.... ........... <br /> P �� Material . . _4`G�N�47 ............. <br /> No. of compartments...-___.3-.......Size_.,(#Ar /.._Liquid depth.....,r.. -----•.Capacity-.., .GItP . � <br /> Disposal : Distance from nearest wel(_�'S.Q..'.Distance from foundation._. ��'...Distance to nearest lot lint�.t <br /> Number of lines_...... Length of each line..... .0...-... .Width of <br /> rn <br /> Type of filter material_ !_..Depth of filter ma+erial./ .........Totel length__./.-R.d...:........................ <br /> Seeps it: Distance to nearest well../ ....Distancef� foundation..o. .. . <br /> . ...Distance To nearest lot line-le-67. <br /> Number of pits......'„..-....------Lining material+A%*t...Size: Diameter... .�r�,.:.'�......Depth... $.'..!............. .r <br /> Cesspool: Distance from nearest well.................Distance from foundation.............-------Lining material........................-----------. <br /> 1 <br /> 171 Size: Diameter..........-----------........—Depth.---....----......-••---......---......---._..Liquid Capacity..._....-----..._.....--gals. q <br /> %.0rivy: Distance from nearest well..._............................................Distance from nearest building..............._..........__ •/S <br /> ❑ Distance to nearest lot line.................................. ...............-...-•-----"--' L° <br /> Remodeling end/or repairing (describe <br /> ):..._,10r: T.�' .� &—_-----.-.----- <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 Iles and regulations of the San Joaquin Local Health District. <br /> (Signed)........... ............... . --. . -----,,, .------- ------ ._....(Tit1eJ.� �wnq nd/or Contractor) <br /> -------- ......By: ..... -- <br /> (Plot plan, showing sizeot, lo�syst in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY... _ .. ,,.ray. e.ae�.�L. -........... .....................-.-.------.. DATE..."3:- ...:(. ................._......... <br /> REVIEWED BY..............-. ----........- <br /> . .................................................._.................................. DATE.....................-.........._..... ---- <br /> BUILDING PERMIT ISSUED................- -----. -.. DA� - -- - -- <br /> rations and/or recpmme fiats:._...... _ - �[..p�� ........ jY.. <br /> :.......... . . .. . ._ .... ... .......1 -..... .�s _......... <br /> z <br /> ::- � : ---% 1 '.... ......�:_:::::: <br /> ......... ..........................................................--......._........................._.......... . . -----.../............................._........... <br /> FINAL INSPECTION BY:.....4:q�..<. ....� Date...........7 /..,5 ...... <br /> (� SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.H...It.Ave. 200 Wert Oak street 124 Sycamore Stmet 205 West 91h street <br /> Stxkfon,California Lodi,California Montero,California Tracy,California <br /> r.P.Ca. t <br />