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FOR OFFICE USE: <br /> -----Lt i:z b 4 I .�"�. APPLICATION FOR SANITATION PERMIT Permit No. <br />---------------�------------------------------------- <br /> (Complete in Duplicate) "`` <br />-----------=--------------------------------------------- This Permit Expires 1 Year From Date Issued <br /> 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 Ordinance No. 549. <br /> JOB ADDRESS AND LOCATON,:*_ --1--6 . -• ------------------------- <br /> Owner's Name------------ <br /> Address-_.......... '�Sc --------_..... ----•-•---................... . <br /> ........... <br /> Contractor's Name .. .. �y r ---- t-----_-----••---•-- Phone fit.. _7 s/ <br /> . . <br /> Installation will serve: Residence 23-'A-partment House ❑ /Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ a <br /> t <br /> Number of living units: ..... Number of bedrooms .__ ___ Number of baths __`--. Lot size _ �__ _ _ ________________________________ <br /> Water Supply: Public system W/mmunity system ❑ Private ❑ Depth to Water Table !ftp ft. <br /> Character of soil td a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeg Hardpan ❑ <br /> Previous Application Made: !If yes,date--------------------) No ❑ - New Construction: Yes ❑ Nox FHA/VA: Yes ❑ No ❑ k <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:' <br /> No septic tank or cesspool permitted if public sewer is available within 200 feet.) i <br /> 1 � �C- <br /> ptic Ta Distance from nearest well_____________•_Distance from foundation--------------------Material_................................................ � <br /> No. of compartments-----------------=........Size----------------------rt........Liquid`�der�pth- "----------------------Capacity--•---•.......----. <br /> posal geld- Distance from nearest well—t6ge._Distance from foundation._,50......._.Distance to nearest lot line....1F �.. <br /> Number of lines________I________ _ Len,tii of each line-____ <br /> -; --- - 9 --�-----F�----Width of trench-----=--�-•�...............�i <br /> Type of filter material,.._._ OC-Depth of filter material-------/X_____---Total length--------=Z.t9.......................... <br /> g � .. <br /> e Distance to-nearest well_- _ _-..nl,.c�._-_-_Dlsfancelfrom foundation---_�.�:......Distance to nearest lot line�_._/_____-.._' <br /> Number of its.._.. Linin material__ __-E1_ _ __-_Sizg:,D•ameter-_-_- « <br /> P �---•--------- g �� .�.> ��-'---..Depth.......���...............•�... <br /> Cesspool: Distance from nearest well-----------------Distance from foundation___- 1-----___.Lining`material..................................... <br /> � <br /> Size: Diameter-'----------------------------------De th---------------------------- - -__ Liquid Capacity <br /> ❑ P - ------ - -------= q - •----•�----•--------------.gals. <br /> s e_ <br /> Privy: Distance from nearest wet!____________________________ -,_-_,_---__- ------- <br /> ---------------- from nearest building_________---__-_-_----_-_•____---.___._..71 <br /> 11 Distance to nearest lot line ----------------------'---- ---------------------------- ---------------------------------------------------------------------- <br /> Remodelingand/or repairing (describe):------------------------------------------------------------------------------------------ ------------•- -_------------•---------------•------ <br /> -----------------------------------------------------------------=----=-------t------::::: --- T7------------------ <br /> ---------------"..`------------- - ----------------------------------------- ---------••------------ .------------------------------------- <br /> I hereby certify that I have pre parea�lt-iiS application and that the work will be done in accordance with San Joaquin County I <br /> ordinances, S e law and rules an regulations of the San Joa uin Local Health District. , <br /> r j�, � t <br /> (Signed)------Ike- � �A I -f'J� ��1.. � / t--- 4� s.. --------------------------------------- Contractor) <br /> By:------------------------------------ -- -- --- (Title) <br /> (Plot plan, showing size of lot, location of system in relation to buildings, $rc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- ------- -- ------------------- ----------------------- DATE-.. -•--------------- <br /> --------�---REVIEWED BY--------------------------------------- ------------------------------------------- DATE----------------------------------••----------------------- <br /> BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:---- "��-- -------------------------------------------------- <br /> ---._...... .......................­­ --- <br /> -•---------------------- ------------,--- <br /> i <br /> FINAL INSPECTION BY:_- '------ - ------- -------------------- Date----/. - J----------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamare Street 205 west 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 0 REVISEa 5.54 EM 5-61 At LAS <br />