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- " FOR OFFICE USE: <br /> T <br /> ak�`--�-(_�,.J --------------------- Gr Permit No. f f � <br /> $�t7Ic�:_---------_-----. &--� APPLICATION FOR SANITATION PERMIT <br /> /;Af( _b '___________________5r-f.R (Complete in Duplicate) Date Issued <br /> -------------------------------------------------- This Permit Expires 1 Year From 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 /> This application is made.in compliance with County Ordinanncce1 No. 549. <br /> JOB ADDRESS AND LOCATI ..xe.4—/----- �r i `dam- !' - ---------------------- -----------•-•--------------------•---------------------------- <br /> Owner's Name.----- <br /> Phone------------------------------------ <br /> -3----.r'-r �-- .-••------ i <br /> Addressr =---------•-••--------------------- <br /> -1 +� .0 yr <br /> Contractor's Name----- •-• --= ,6_��- =----------------------------------- t---- ----- ----------------- Phone---------------------------------- <br /> { <br /> Installation will serve: Residence ❑ Apartment Hou e [ICommercial jailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __, : Number of bedroims _:071Number-o�f baths _ -- Lot size __ __ l ----------------------------- <br /> Water <br /> - ----------------------- <br /> Water• Supply: Public system Community syste h�C] •P`riva+e ❑ Depth to Water Table ------- ft. "" t <br /> Character of soil,to a depth of�3 feet: Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay F] Adobe � E]ardpan I <br /> Previous Application Made: (If yes,date-------------,_.+_..I No I�.New Construction: Yes E] No `FHA/VA: Yes E] No Z�— <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: # <br /> (No septic tank or cesspool permitted if public'sewer is available within 200 feet.) r ! <br /> Septic Tank: Distance from nearest well------ ------Distanc11 e from foundation-- ��-- e__ Material -���------------ ! <br /> Size <br /> No. of compartments----�----------------=- ... _ -_,?__Liquid depth.---- CapacitY•/l�l41---!�-----• , <br /> Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line--------------.._ <br /> ❑ Number of lines-----------------------------------Length of each line------------------------------Width of french.------------------ --------------- <br /> Type of filter material-------------------------Depth of filter material-----------------------Total length -_ -.----_---:-_--_--------_----_-_-__ \ <br /> Seepage Pit: Distance. to nearest well----------------------Distance from foundation---.----------------Distance to nearest lot line--------------__-- (o� <br /> ❑ Number of pits----------------'------Lining material----------.------------Size: Diameter-----------------------Depth--------------------------------• \ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation__.-----------------Lining <br /> _ material__.-__-____----._-.---_----- <br /> -_-_- <br /> ---. <br /> ❑ --- - Li Liquid Capacity----------------------------9als.th-------------------------------------- <br /> Privy: Distance from nIearest we'll------------- ------------------ ------ --Distance from nearest building- - ---------------------- - ------------ <br /> ❑ Distance to nearest lot line-- ------------------------------------ -------------------------------------------------------------------------------- ------------ <br /> Remod •ng,and/or rep iring (describe):----- -�� �'� �� ------r�-o '------- ` `�" ------ <br /> 4 __ -------------------- <br /> A.._ ti`- <br /> ' ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------._--._--------..---.______--_-. <br /> I hereby certify that l 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)---------------------------- ......1&�/.._� ------ --- ---- ------- ------------------------------------- 4/or Contrac+or) <br /> gY:---------------------------------------------------------------------------------- Y -------(Title)--- /�'��'---------- ------------- -------- <br /> (Plot plan, showing size of lot, location of system in relat' to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- ------�-__ Amcd s---- ---------------- DATE------q6 ' 1:ip= b5------------------------ <br /> REVIEWEDBY-------------------------------- --- --------------------- ------------------------------------------------------------------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED---------------------- ----- --------------------- --------— -- ---------- D 7E ----------------------------------- <br /> 1#erations and/or recommenda+ions:-_& _(P..'Sps---------I' -----.------------- 'y- ------t-y---------- ------ -e�-isie�R.c. 'g-5----- <br /> ----------F-=-!7."3-------- °`� - 1-- �R. <br /> --- - ----- <br /> rte, - ---- ---------- --- .. � '" <br /> --------------------------- 4 <br /> FINALINSPECTION BY:------. 61. ----------------- ------------- ---------- Date...... ----------------------------------------- <br /> SAN JOAQUIN LOCAL. HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> —i'aiiiton,California - <br /> - ^` Lodi,California Manteca,California Tracy,California <br />