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r- <br /> ----- <br /> ----- - ---- -- - <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> - - -------- - <br /> (CoThis <br /> Application is hereby made to the San JoagPermit.t4t'al EHa th District for <br /> permit <br /> t to coon u plete- Date Issued. d. <br /> Li construct and install the work herein-des�rlbed. <br /> This application is made in compliance with Cunty Ordinance . 549. <br /> JOB ADDRESS AND O ION - - � <br /> L c - -- -- Phone 1' — 7� <br /> Owner's Name._/_.__yy _ _____ ._ ___.,. _ __ _ <br /> Address... �mC -�� - - - - ------------------------------------- - - -- <br /> n - -- - - ---------'(------------ - - '// <br /> LContractor's\Name_ h-- !--s"��� ._J°"--� Z ----------- ---'----------- --------------- Ph one_.,&O�--`--VJO-f7--- <br /> Installation will serve: Residence P6 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _I----- Number of bedrooms _ _ Number of baths__.t_ Lot size ..67C :-&--_---.------- <br /> 6 Water Supply: Public system ❑ Community system ❑ Private Pa Depth to Water Table &_ ft <br /> Character of sail to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam Z Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> ` Previous Application Made: (If yes,date--- ,_---__------. I No ® New Construction: Yes ❑ No [$ FHA/VA: Yes ❑ No a <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) � A- <br /> ` Septic Tank: Distance from nearest weIL .Q�_._Distance from foundation._.1Q .__._..Material_-LPJnf�t-v 1 <br /> - -------------Liquid depth--- s. -'�__.---Capacity._-.-_---- <br /> Q No. of compartments__._�-_...._....._Size.__� C�_ <br /> Disposal Field: Distance from nearest weir- _-_Distance from foundation._./'.......Distance to nearest lot <br /> © Number of lines._______-�'_ .-__-___Length of each line__.�d'.____-- Width of trench...-P2-'l .._._...___ <br /> Type of filter material-- 00K_- ---Depth of filter material..../.8?�--------- length_...6s- _ <br /> Seepage Pit: Distance to nearest well-----------------_---Distance from foundation-----------------Distance to nearest lot line <br /> ❑ Number of pits------.._. .-_._Lining material------------------ . Size: Diameter----------------- ----Drafl-, --------------------. <br /> Cesspool: Distance from nearest well -----------.__Distance from foundation_.------ ------- ..Lining material__.._-q,, at:--------._-_.... <br /> ❑ Size: Diameter- -- --------- ---------Depth-----------------'-------------`-------Liquid Capacity....----- -------gals. <br /> L. Privy: Distance from nearest well---_.----------- ---- ---------- ----- --Distance from nearest building._—___---------___._..-__-. <br /> ❑ Distance to nearest lot line --------------------------/--------------------------------------o---o---------------------------------..... ...... <br /> ` Remodeling and/or repairing (describe):---PG�2.__/`.:.F�[ -Com.-..- -�- --------------- ----- <br /> -­--------� ------ <br /> ----- ---------------------------- -------------------------------------.-- <br /> - ------------------------------------------ -------------------------------- ------------------------------------ ---------------------------- --- c�� <br /> --- ----- --- ---—------- -- - <br /> --------- ------- ----- --------------------------- - - --- - <br /> - - ------- -- --- <br /> V 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun <br /> Ordinances�State laws, andel rules and regulations of the San Joaquin Local Health District. <br /> ` <br /> (Signed)--"_--------- t= 'r-x- c,SG/da6��----...._.._------------------....-------- ----._.-_. .___IQwner and/or Contractor) <br /> /- - L`/`Ja-�... �/ <br /> ----- ---'--------------- --------(Title)--- -- `---- ----- ---- ------__---- <br /> -- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). G <br /> L FOR DEPARTMENT USE ONLY l <br /> APPLICATIONACCEPTED B - -----------------....----------- ------------------------- DATE- ----- .---S ?--------- --------- <br /> L REVIEWED By <br /> - - -------- --------- - - ----------- ----------------------------------------- DATE ----------------- ---------------------- <br /> BUILDINGPERMIT ISSUE - ------------ --- ----------------------------------------------- - DATE--------- -------- ----- ------------ --- <br /> Alterations and/or recommendations:_----_----... .----------------------._-------_------------------.------- -------- <br /> - <br /> ----- - -- --------------------- <br /> -- -- <br /> ----- <br /> --- - ---------- <br /> - <br /> - - ->-- ----- ------ - - <br /> -.. .. <br /> ---- -------------------- ------------- --------- ---------- -------- - --------------------------- <br /> FINAL INSPECTI BY:... __ _ . <br /> _-__ Date-._._....--- - .-.____............... <br /> -. <br /> 1 <br /> JO UIN LOCAL HEALTH DISTRICT <br /> 1601 E.Resellon Ave. .300 West Oak Street 124 Svsern.re 51,-t <br />