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FOR OFFICE USE: <br /> ...... .. ... ...... .... ................. __- <br /> ............ . . ... . .. ........ .. _ . ..... . APPLICATION FOR SANITATION PERMIT Permit No. ..tT� <br /> .. .......... _ ...... ......... ......... (Complete in Duplicate) <br /> This Permit.Expires 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 the work herein described. <br /> j This application is made in compliance with County Ordinance No. 549. <br /> 1 <br /> JOB ADDRESS AND LOCATION7yp <br /> ......1.5.4..3.. .....-9G'......,� .... <br /> Owner's Name... <br /> c0.... <br /> ....... ........;,`,,...................•.•........ ....................................... Phone .'.cam... <br /> Address.... 1.. .... .. .......... ?!`.1....,. ..1..:�.......... .................. <br /> Contractor's Name..%.'' ... . .............4t.� �...... <br /> Installation will serve: Residence �Xpartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of lining units: ....... Number of bedrooms .3.... Number of baths ..(.. Lot size ..... ...................... <br /> l Water Supply: Public system p Community system E] Private p?bepth to Water Table ye. ft <br /> Character of soil to a depth of 3 feet- Send ❑ Gravel ❑ Sandy Loam❑ Clay Loam lay❑ Adobe❑ Hardpan 2r-,-- <br /> j Previous Application Made: (If yes,date.. .. .. ....— ) No;Erl'New Cons+ruction: Yes Q/o ❑ FHA/VA: Yes ❑ No <br /> 7 TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> i <br /> forSeptic Tank: Distance from nearest well.-Av......Distance from foundation...A7. ......Material.. <br /> No. of compartments.... ..�.../.....Size.rJ x.9"���.....Liquid depth.91.1.. ..... ...... <br /> Disposal Field: Distance from nearest well .....Distance from foundation...:I. .......Distance to nearest lot line........... <br /> (]� Number of lines...... g <br /> �.......... ........Len in or each line....��'..../........'Width of trench. ...................... <br /> Type of filter meteriaL. .... ...0epth of filter material...��.............Total length...`pQ�................_........ <br /> Seepage Pit: D':tance to nearest well.....SV.........Distance from foundation....-M.'....Distance to nearest lot line...?0...... <br /> [� Number of pits....._-�.......Lining material.-4�...... Size: Mameter...Y.X-t......Depth....1.`P.. ..................... ' <br /> Cesspool: Distance from nearest well................Distance from foundation...................Lining material..................................... <br /> ❑ Size: Diameter... .................. .. _..— Depth..............._.......................... .....Liquid Capacity.. ........-...............gals. �l <br /> Privy: Distance from nearest well.... . .... ... ................ ....... Distance from nearest building.......................................... <br /> ❑ Distance to nearest lot line... ....................... ..........................------........................................................................... <br /> ( Remodeling and/or repairing (describe):................ ...................................................................................... ............................... <br /> { <br /> ...................................................................................................................................................................... <br /> ..................................................... <br /> ..............................................................._................................................................................................_.......................................................... <br /> t <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 rules and regulations of the San Joaquin Local Health District. <br /> (Signed).. .. ..... ...... .._... f!": u%. ............................... (Owner and/or Contracfor) <br /> By:— ..... �..............................---............... )_._ <br /> . ....�, (rile _... <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placedde). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.... 49.0- -... . . . ... ... .. ..................................... DATE......It..... J.................. <br /> REVIEWEDBY............................................................... .._.... --._ _ .. .................................. DATE............................................................ <br /> BUILDINGPERMIT ISSUED.................... ....................._...................................... DATE............................................................. <br /> Alterations and/or recommendations:..... ✓1..T. DEPTHS_ /1r ..1:....CHEt~-IK I�. ........�1��.P. ...................... <br /> 1�.�FQR.E .... Fi iv A ....INS?..mac Zcol (.r.................................. ................................. <br /> .........................................................../... - _ .. .... ....................... ............................................................. <br /> ...... ....../ <br /> / Date..... . 2 ................................ <br /> FINAL WSPECTIOr l;� '-s-'-/ ••••• �•�.-'_��_. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 1.Hazelton Ave. 300 Wert Oak Street 124 Sycamore Street 205 Wort 9th Street <br /> Stockton,Ca llfornia Lodi California Manteca,California Tracy,California <br /> E H.9 2M 1-67 Vonguard Pins <br />