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/ 1! 1\..L VOL: - - <br /> �� f ----------- <br /> ---- APPLICATION FOR SANITATION PERMIT Permit No. <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 /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCAT ON..___ici_ - �(6700 <br /> - •--------------- <br /> Owner's Name-------4-Y <br /> Address__. e) - Phone. <br /> - ----L/------------ ----------------- <br /> ------ - ------------------------ <br /> -- '�--------- f ------------ <br /> 11 � lx r rJ� <br /> Contractor's Nama_ - - - -=-------- ----••--'--i----••,,--------------------.------------- ------------------------------ <br /> -------------------- Phone <br /> Installation will serve: Residence <br /> [3 Apartment House ❑ Commercial [] Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __---1. Number of bedrooms _ �- Number of baths -�~--- Lot size -Z <br /> Water Supply: Public system E J Community system ❑ Private ❑ Depth to Water Table /0,7 ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam El Clay ❑ Adobe Z]- ardpan ❑ <br /> Previous Application Made: (If yes,date-------___----------) No 0-1"-New Construction: Yes [2 No ❑ FHA/VA: Yes ©—No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Distance from nearest well-----`----------Distance from <br /> ® ; foundation__ ---'.--.Material- <br /> No. <br /> -f-_-_Mat_erial-No. of compartments f: � -- �C ,:�� <br /> �i ------ <br /> - -----------Size--- _� •---Liquid1 ---------- py---- O� <br /> Dispasaield: Distance from nearest well__- --------Distance from foundation/� ----_-Distance to nearest lot�ine__1.-__�-___ 'J <br /> Number of lines------ ___�--��. .___.___Length of each line-- _, �'-,Width of trench_.trench--- <br /> Seepage <br /> Type of filter material___�_�!� _ -___--.Depth of filter material_-l/f- � � <br /> - --------------- <br /> -- -------- Total length-----���--------------------- ��� <br /> Seepage Riti Distance to nearest well..__- `-`"-___--_-Distance fr m foundation__ d �- Distance to nearest lot line~�f Q <br /> Number of pits__-r -------------Lining material--_ ! ___..Size: Diameter,/f-_-__-_--De th-- ,f_l_id�{ � <br /> P - -------------- ------ <br /> Cesspool: Distance from nearest well-------------_---Distance from foundation._- _---___-.Lining material...........___-__-------_--__--_-- <br /> ❑ Size: Diameter---- --- ------- - ----- ----------- <br /> Depth------ --- ------------------ --------- --------Liquid Capacity-.-.------------------------gals. <br /> - <br /> Privy- Distance from nearest-well----- --------------------------- ----- - -Distance from nearest buildingr <br /> ❑ Distance to nearest lot!line-- --------------- --------------- - 4 <br /> Remodeling and/or repairing (describe):_---____ <br /> ---------------------------- <br /> ----------------------•-_-•-----•_.__-_.__-__------____-_____--`---------------------------------------------------------------------------------------------•--------------------------__-_----------____-__-._--__._--••_--- - <br /> --------------------------------------r------- =---------------------------------------•--------------- ---------- <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,Iaws, nd rules'and' regulations of the San Joaquin Local Health District. <br /> 1 <br /> (Signed- <br /> - -----------( caner and/or Contractor) <br /> N <br /> ----- -," ----- = � ,fir----------------------------------- --------Title �.. x .. <br /> (Plot'plan, showing size of lot', location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- ---------- ---- --- ---------------- --------------- DATE----------- <br /> REVIEWED BY--------------------------------------------- DATE---- -- -- <br /> UILDING PERMIT ISSUED------------------------ <br /> `Qlteras' n <br /> and/or recommendations:-------- <br /> T <br /> ------------____ <br /> -------- - ----------------------------------•--------------- --------•-----------•------------------------------------------------- <br /> ------------ ------- --- ---- - - <br /> _ <br /> ---------- - --- -- '` �r <br /> FINAL INSP TION BY:_.- �14, <br /> r <br /> ------------------- ----------- ------ Date_-.---- /d1­3.11' .5�6 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haselton Av*• 300 West Oak Street 124 Sycamore Street <br /> 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />