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APPLICATION FOR SANITATION PERMIT Permit No. .. 1/ _-.._ <br /> ------- - ---- <br /> ...... -- ----- (Complete in Duplicate) <br /> Date Issued <br /> ----- --------------------- --------------- This Permit Expires 1 Year From Date Issued <br /> L 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. / ;7 lr C� <br /> JOB ADDRESS ANDOCATION_Vj ---,COfx,2L9__ --_-.-..- . <br /> Nam( --- --- <br /> - �-------- -- -- Q <br /> L Owner's Nam <br /> Address------._------ ----- -- ------------------------------------ ------ - -- --------------------------------------------------------------------- <br /> ----------- --- ------------------------ `/ <br /> ' Contractor's Name--------- `/— ----- --- -------_.-ems/- ---------`----------------------------------- Phone_"""/ w`_/_�4 <br /> V <br /> Installation will serve: Residence Lb Apartment House ❑ Commercial ❑ Trailer Court ❑ /Motel [I Other El <br /> Number of living units:/--- Number of bedrooms _-3- Number of baths _t..z2 Lot size _-.Z<_ ,d/ <br /> `t Water Supply: Public system ❑ Community system ❑ Private 9j"bepth to Water Table F--0 ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ .Adobe 2--'Hardpan ❑� <br /> Previous Application Made: (If yes,date_____...,--------) No Er_ �New Construction: Yes ❑ No �HA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet,) <br /> ank; Distance from nearest well----------------- from foundation.-__._.__-..._-_.Material.......................-_._-..---..._.._---- <br /> No. of compartments---.--------------------Size----------------------------`-Liquid depth-----.-----__------,Capacity------------- <br /> -- Disposal Field: Distance from nearest well_J.v._--Distance from foundation._. _ ._._..Distance to nearest lot <br /> ❑� Number of lines----------- ._.__ _ Length of each line--- ....Width of trench--_. -l� <br /> r f <br /> Type of filter material.____i_- �W-Depth of filter material- _/S/ length-_,e/e.4-------------------._�, <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation_----------------Distance to nearest lot line.____._._____lip __ <br /> ❑ Number of pits----------_--------_Lining material------ -------------_Size: Diameter.------------ --------Depth------__-------._--._..._----- <br /> Cesspool: Distance from nearest well.:---------------Distance from foundation., Lining material--------------------__.__--- <br /> .__.(� <br /> ❑ Size: Diameter_.--------------------Depth-------------------------------------Liquid Capacity--------------------gat \ <br /> V Privy: Distance from nearest well-----------------.--------------- ---._.-._Distance from nearest building------------------------.---_-_._....- <br /> ❑ Distance to nearest lot line.----------._---------__----._-. ----------------------------_--------- ._-_.. <br /> Remodeling and/or repairing (describe):---`----------------------------------------------------------------`----'--------------------------- <br /> ` - <br /> -------------------- ------------------------------------------------------ ----------------------------------------------------------------------------­--------------------------lzz�'l <br /> --------------------- ---------- --------------------------- ------------------------------------------------------------------------------------------------------------------- U <br /> - ---------------------------------- -------------------------------------------------------------------------------------------- <br /> 4 I hereby certify that I have prepared this application and That the work will be done in accordance with San Joaquin Coun+y <br /> ordinances. St laws, and rules and reg tions of the San J �aquin Local Health District. <br /> 7j 1(Signed)------- -- ------- - -------- -----J --- -- -------- - (O er and/or Contractor) <br /> Ltle... ✓/ 1�GL <br /> By:. - - - -c fes, o -'---------------- --------( ) - - - ... - ---- <br /> (Plot plan, showing size of lot, location of system in relation e Is, buildings, etc., can be placed on reverse side). <br /> FOR DEPAR��RTMENT USE ONLY <br /> - APPLICATION ACCEPTED BY-- -------- -- --------- --- --------------- <br /> ------ ----- <br /> -- E-- - - - -- <br /> I REVIEWED BY----------------------------------------------- ------------------------ ���AATE - - -- --- ---- -- <br /> -- ------------ <br /> BUILDING PERMIT ISSUED.___-_----------------------------------------- <1---- ------ FATE ---- <br /> 1 - - - - - - <br /> Alterations and/or recommendafions:._.____------. ' )f <br /> -------------- <br /> 1 . <br /> 6W -------------------------------------------------- --------------- ------------------------------------------------------------ ----------------------------------------------- <br /> ---------------------------------- ------------------------- ----------------- <br /> -- --- -- <br /> -------------------- ---------- -- - - - - - -------------------- - - - - -- <br /> -- - - - ------ (/, � <br /> i Date....-----`/-� '/'/--�---"' _ <br /> FINAL INSPECTION BY:-------------- - - `-1------ --- -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br />