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L <br /> rUK Urrt(_e Uae: <br /> L - --- .-.- ...- -- - - <br /> APPLICATION FOR SANITATION PERMIT Permit No. .__.�_��L _... <br /> (Complete in Duplicate) Date Issued ._,1P ��� <br /> _ This Permit Expires 1 Year From Date Issued // <br /> LApplication is hereby made to the San Joaquin Local Health District for a permit to construct and install th r herein des ri ed. <br /> This application is made in compliance with County Ordinance No. 549. `- <br /> LGv <br /> JOB ADDRESS AND LOCATIONSEZ�,I.4lFlr'_11fir�1: / tY4-- !-- �r�/ v_�._.f/Xr.O -�Lk11111 .✓ <br /> r / <br /> Owner's Name--- -•Cne�/ ----- ----- - - - - ------ ----------- ------ - Phone---- -----------`--- <br /> ' ; lAddress--------�_LA� l -_ l __Q -- --------- '--- <br /> -- <br /> LContractors Name---------- - B-rr�--. - lF.�-- �f"-- --------------------------'------------------------------ Phone-----'-------.'_.--------'--' <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ._ Number of bedrooms_ Number of baths /.._ Lot sizeela_eB--- <br /> v Wafer Supply: Public system ❑ Community system ❑ Private Z?<epth to Water Table - _It. <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,dote ..) No �K New Construction: Yes JR'lNo ❑ FHA/VA: Yesl ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic fank or cesspool permitted if public sewer is available within 200 feet.) Q <br /> -. ----._-_..Matey ial__4._ �.^.-f ' <br /> Septic Ta Distance from nearest w II�l.._Distance// rom .fl,��+dation_�� <br /> No. of compartments -_-----_._._._Size Q.. i fluid depth__._��_. Capacity/"_A__ . <br /> j <br /> Disposal Field: Distance from nearestwell.,,well."- -- --Distance from founda "on f r�/.___.Distance to nearest low line_*__________ <br /> kL Y!a Number of lines__1s_._.__.,___ _____Length of each line_.Fe_._._ Width of trench _ __ .__.._._._.___-_ <br /> Type of filter material !?G Depth of filter material.. _____---Total length._ :.__________._._.-- <br /> Seepage Pit: Distance to nearest well----------------__.Distance from, foundation_.__-___-.._..Distance to nearest lot line---- S <br /> L 11 Number of pits___.__.__.__--Lining material_-_-....:............Size: Diameter---------- -----------.Depth-------------------------- <br /> .__.. <br /> Cesspool: Distance from nearest well Distance from foundation...._.__........Lining material___-__.-.-_._..--.--_._._._. <br /> L ❑ Size: Diameter------------------------.-Depth--- -------------'-- --------------Liquid Capacity--------------------- -----gals. <br /> Privy: Distance'from-wrest well----___------------------------ -------------Distance from nearest building-------_._----------------__-..... <br /> f ❑ Distance to nearest lot line.._________._-.-_---__ .._____ .-_.___ ------------ <br /> --- <br /> �fl <br /> L Remodeling and/or repairing (describe):__..__. _- _ ----___-- <br /> ---- - — <br /> Yrte` — ----------`-'---------------'--------------- <br /> ------------'---------------------- --------------------------- --- <br /> -----------------------------------------------'------------------------------------------------------------------------------------------'--------------------------------.--------------------- --- <br /> 4 1 hereby cerfify that I have prepared this-application and that the work will be done in accordance with San Joaquin County <br /> ordinances. State laws, and rules ad regulati76o,�nls of fhe San Joaquin Local Health District. <br /> L (Signed)---------------------`` --Ir .- - ----------- <br /> - - ----- _ -- - ------( Contractor) <br /> By:--------------------------------------------------- ------ ------(Title)- ------- <br /> j <br /> r---- <br /> (Plot plan, showing size of lot, location of system in re(afio wells, buildings, efc., can be p ced on reverse side). <br /> rFOR D ARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----_ ----- -------- --------------._.____ - _., __ DATE -------------__._. <br /> REVIEWED BY---'---------- '--------------------------------------- ------ --------------- DATE.-f - — - <br /> BUILDING PERMIT ISSUED' - -'- ' '- - - -- -- 1I DATE-----L ------------ ------------- <br /> --- - - <br /> Alterations and/or recommendations---------------------`------------- --------------'---------- -- ------------------------------------`----------------------------------- <br /> L ------------------- ------ ----- ------------------ --------- -------- --------------------------------------------- --- <br /> L -----------....--- - - -------- ---- - - - -- - - - ------ - ' <br /> r[ <br /> / .:- k <br /> FINAL INSPECTION BY:.. - - - ,.. -- - -- `..- - Date----------- l- — - - ----------------------- <br /> L -- --- -L - SAN-JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak street - 124 Sycamore Street 205 Wezt 91h Street <br />