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� FOR OfFI SE: <br /> --�f-'-�-b..-.t -- '���+ --Vit•--•�l-'t}- <br /> APPLICATION FOR SANITATION rmit No. .).3. :5--�' <br /> - ....... (Complete in Duplicate) <br /> Date Issued ................ f <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 Ordinance No- 49. <br /> p s 7:z <br /> ............_------------------------------------------------------------------------- <br /> ON--=`S-•----(?_S•--- -. <br /> /. / ••-------•----- Phone ... --------- <br /> Owner's <br /> _...... <br /> O ------- <br /> JOB <br /> Namse._AND OSA 11tc.-t... h- -------------------•-••----------------------------------------------- <br /> Address <br /> -•--•----•----__..--- <br /> � 7 <br /> Address-----------------------------••-•---------•-: ----•-------•-7-- -------------------------.......................................................-.......................--_....... <br /> F1t:�f <br /> Phone............................ .... <br /> Contractors Name....... =-_ <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trader Court ❑,,// Motel ❑ Other ❑ <br /> Number of living units: ._j----- Number of bedrooms_2_-_ Number of baths 2- Lot size .,1,[.- =�L bre--•••• •••••---•--•......-......-•- <br /> Water Supply: Public system ❑ Community system ❑ Private ❑-'Depth to Water Table .S ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay❑ Adobe ET Hardpan ❑ <br /> Previous Application Made: (if yes,date....................) No New Construction: Yes Q/ No ❑ FHA/VA:Yes ❑ No[2- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) /.� <br /> j _ , {, <br /> /O.....•....._.Material-_t'p%`_r % ._..:L-_---:=_------�---•---_ <br /> Septic Tank: Distance from nearest well Distance from foundation.____ k <br /> No. of compartments--._..1---------------Size._._J -• ..li .- ...Liquid depth..... ---... <br /> -----------Capacity...LDiz_:.:{.2_ <br /> Disposal Field: Distance from nearest well.So..........Distance from foundation.lJ._......._..Distance to nearest lot fine.._.ti_...._._._ <br /> 'Number of lines..............'�:__ <br /> ---------------Length of each line-----_..fir -•----._....Width of trench----.--- '- •-•------------ <br /> Type of fitter material.......1a1__k.--------Depth of filter material_._-!.$-----------------Total length._...,._..__Js: ._______............ <br /> 0 <br /> Seepage Pit: Distance to nearest well_. 62..............Distance_from foundation.Zk._---_--___.Distance to nearest lot line _f..._____.. � t <br /> Number of pits_...-'1 -----------Lining materieL..._� <br /> ....Size: Diameter.-- 3..............Depth_._....__.,eke.__----------- <br /> _.. �V <br /> Cess❑p000i: D_ytance from nearest well.................Distance from foundation....................Lining material----------------------------------- <br /> ❑ Size:_Diameter---------------------------------------Depth-----------------•--..............................Liquid Capacity---•-----••-----•----.---_gals. <br /> Privy: Distance from nearest well......----------------------•-•____...-.---------Distance from nearest building.-----_-..._-_.__._-__---__-..___.__---.-. <br /> ❑ Distance to nearest lot line---------------------•---•-- •--•-----------------•-•--------------•----------•----- <br /> Remodeling anal/or repairing (describe):........4-.... --..---------.--------•-----•--••- - --•-•--•------_- <br /> I hereby certify that (bava prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and,.4i S and r ` ulations of the San Joaquin Local Health District. <br /> --.....___(Owner and/or Contractor) <br /> ­­ <br /> (Signed)_ <br /> By:._....---•-._._.,.....:: �� t � ............................---------------...........................(riitle)...........---------------------------------- ----------------- <br /> (Plot plan, showing sae�f,location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.._ - --•••--•••--•-••-................-••-•- <br /> DATE....-•/....... / --- -----------•------•- <br /> ----------------------- <br /> REVIEWED BY----------------------------..............................................•------------------------------------..........---- <br /> DATE----------------------------------------------------- <br /> BUILDING PERMIT ISSUED------------------------- -------••-•-----•--••- <br /> .............................. <br /> DATE-------_------------------------------•--------------------- <br /> Alterations and/or recommendations............................ ................................................................. -----_--------------------------------------------------- <br /> .................. -- <br /> --.- <br /> -- <br /> ----��-----� <br /> --•.....:...............•.......-------••............ w <br /> .--�•-----..E- ---- --F Date._..w:._.... <br /> FINAL INSPECTION BY: <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,Collfomla Manteca,California Tracy,California <br /> ca•a ecvuco e•aa r.�.cc.sµa•ao <br /> i <br />