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------------------------------------------------ <br /> - -------- -------------- ----------- - --- --------- AAPLICATION FOR SANITATION PERM Permit No. <br /> - <br /> ------------------------------- -- --- --------- (Complete in Duplicate) <br /> This Permit Exaires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install f)rwork herein descrlTjed. <br /> This application is made in compliance with County Ordinance No. 549. `( <br /> v, JOB ADDRESS AND LOCATION$ k.�Nb-./12/J_Pi_151 _ ...�jZl�. _,tt'..al.__.._ff�ClJflr,('. . <br /> Owner's Name �y !` 11- h r/ -lr� P� rY = ^ --- - <br /> --- <br /> - ._. Phone <br /> Address.e. g �.���f /1r.F�- 1�Se�� -f F-�ti -- <br /> Contractor's Name- / {� ''�t1Qr�' ---------- Phone---------------------...- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ZKIrailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: f`-_. NUmber of bedrooms �_ Number of baths .vZ Lot size /__ ............._ <br /> [I <br /> Wafer Supply: Public system Community system ❑ Private 4 <br /> Depth to Water Table 40 . <br /> Character of soil to a depth feet: Sand p Gravel t Sandy Loam ❑ Clay Loam Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: II es,dr;Ife.____ _.____-) No PE New Construction: Yes E4"No ❑ FHA/VA: Yes ❑ No F�1— <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.)ses <br /> c <br /> Septic Tank: Distance from nearest well_ _ Distance from foundation.. ilr.....Ma �I ---------------�-'�----- ._.....___... <br /> U• _ No. of compartments..,3-----//.___..----Size `.�f�L., uid depth--- _--------------Capacity_Xl?�O__. <br /> ` Disposal Field: Distance from nearest wel]AKe—.---._Distance from foundation_421. ____-Distance to nearest.lot line..o----- . <br /> ®� Number of Length of each lines-_., ..__t_._ _._-- line_.__ _- <br /> ?'�- - --- ._.Width of trench--12--/- - ---- ------- <br /> Type pf filter materialDepth of filter material..... r�"'---Total length__,:sPdV.'./.......------- <br /> �__ <br /> ` Seepage Pit: Distance to nearest ell_>lG1.L?.�_Distance fr to dation.�_!1'._ _.._..Distance to nearest lot Ii/- ____._ <br /> ®/ Number of pits.. ------------ maferial__ 49;0 Size: Diameter. _ 4ZDepth_�r +_L2_---..__ <br /> p ce from nearest well__..____._.._Distance from foundation....__......_......Lining material_.__._.___.__.._._-____.____. <br /> ` ❑ Size: £7iamefer_--- ---_-_-----------------Depth._----------------------------------------_Liquid Capacity---------------.......gals. <br /> Privy:oo - Distancg from nearest well------_--------._._------------------...___Distance from nearest building------.___..__-..._..__.__....__.. <br /> ❑ Distance to nearest lot line <br /> Remodeling and/or repairing (describe):____. __e 'r✓�{{� f 1-- >r/ .0 ....._.__._....-------.----...__._.__..-- <br /> - -------------------------------------------------------------­­-------------------- - ---- --- ---- -------- -- -- _ -- -------------------------------- <br /> ---------------------------------------------- ---------------------_------------------------------------------------------------------------ <br /> ----------------------------------`-----------I-------------------------------------------- ---------------------------------------------------`--------------------------------------------- V <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 1,Aples and regulations of the San Joaquin Local Health District. <br /> (Signed) - w r Contractor <br /> By----------------------`------------- " ---------------------- - - -/--- ----- <br /> (Plot <br /> ---(Plot plan, showing size of lot, location of syste re at ion to wells, buildings, etc., can be placed on reverse side). <br /> 1 FO DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY._..--- d71- a - -- n--------------- ------------- DATE ---,-- -Z - ---------- <br /> ses <br /> REVIEWED BY--------------------------------- ----------------------------------------- -------------------------------- DATE.--- -------------------- ------------------------------ <br /> BUILDINGPERMIT ISSUED_.-------- ---------_-------------------------- -------------...- ----------- ... . DATE---- -------------- - ----------__----------------- <br /> Alterations <br /> ------------------ <br /> Alterations and/or recommendations: __------------------------------------- .. ----__--- <br /> -------.. ----------------- `----_--_-----`---------------------------- <br /> ------------ ­ <br /> --------------------------------- <br /> -------------­­------------------------- ----------------------------- -------------------------­ ------- <br /> -- - -- <br /> ----- -------- ------------------------------------------I---------------------------- <br /> ...__-------------------------------------------------------------------------- ---------------------------------------------------------- -- ----i------------------.#_----------------------------.. <br /> FINAL INSPECTION BY:...-- J...--l1TZ l --------- - Date............ _-:�• .1 -------------------------------------- <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 /> s F.F.CO. <br />