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FOR OFFICE USE- <br /> APPLICATION._____.__-.._.. APPLICATION FOR SANITATION PERMIT Permi+ No. 1 ------- <br /> .................-.......- - - ----- -- -_- .... (Complete in Duplicate) Date Issued <br /> ................................................ This Permit Expires 1 Year From Date Issued 2-Y�dte D-,� <br /> Application is hereby made to the San Joaquin Local Health District for a permit to_cons uct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 544. j_y� &A/ <br /> JOB ADDRESS AND LOCATIONr._�J• eyt.:p _`.._ a. _-.... " y - - ---- '--------------------- <br /> Owner's Name....... !c 1" C .......... _-----------------­--------- --_..______.__.._____._.__...._...._.... Phone.......... ..................... <br /> 1 , <br /> Address...........�4U7. -,6 -.-.--•----•--- ....-•......... ........... - ...........0�..............--"_--__-._-•.. ._......__..-"-- -" ..................... <br /> Contractor's Name___. —i _ 1 --...__ .?. .._s?_ ` lG -------------•---........... Phone_ L--_-- <br /> Installation will serve: Residence A--Xpartment House ❑ Commercial [) Trailer Court ❑ Motel (] Other ❑ <br /> Number of living units: A- Number of bedrooms --CA. Number of baths ../. Lot size ....A... '?- -......................... <br /> Water Supply: Public system ❑ Community system ❑ Private ' Depth to Water TableQ_4_ ft- <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: (If yes,gate__________ _______I No ❑ New Construction: Yes 0 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.) /bpd <br /> C_c�ltl <br /> Septic T nk: Distance from nearest well.= 'd�..__Distance from foundation_/.6_'-__-_-.Mat�riaV_. ............................... ..... <br /> No. of compartments......vt---------------Size!�rK�',KZ .....Liquid depth.... _-.-------.------Capacity./_stZA__G'." <br /> Disposal Feld: Distance from nearest well.-S.23--------- from foundation._f4_._.._..._Distance to nearest lot line_rS_.._..•__. ^Q' <br /> Number of lines_._ Length of each line� v•"---Width of trench...._.. _________________✓ <br /> Type of filter material-_.,�!_ Q.�_*Depth of filter material____ 'cf.__---__Total length-______---_.__ .r. ,{, <br /> Seepage Pit: Distance to nearest wel;---------------_-.Distance from foundation....................Distance to nearest lot iintl1�1_._ <br /> ElNumber of pits----------------------Lining material......-................Size: Diameter.-.-_-----------------Depth_-_-........_.........._ <br /> Cesspool: Distance from nearest well.................Distance from foundation_..-___..--_...... 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 /> • r. <br /> Remodeling and/or repairing (describe)___________________:!K '-... ---_-----_----------------__-- <br /> •---"--------"...................................................................- ---"--•--"-•--__........... " .............-._.....---•-"---------....---------••--••-•---•-•--•.-....._•----•--------•-••-••---- <br /> --------------------------------- -"-•-- ...................................... <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, Stj lawl, aqd ru Uandegula+ions of tis San Joackuin Local Health District. <br /> (Signed) --.-----•••--•• •------------- ._. _.. (Owner and/or Contractor) <br /> j - <br /> gy:..... - .. ..............(Title) /.._._. __..__.._..-.-.........._........ <br /> . <br /> (Plot plan, showing size of lot, location of system ion to we s, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY _ <br /> �- <br /> APPLICATION ACCEPTED BY......................................---_--------.......------•--.....-----------.......... DATE................+ ............. ......1•l------- <br /> REVIEWEDBY.....-..............................................................................•-•--•-------•-------•--------...----•---- DATE...................................... ---- ............. <br /> BUILDINGPERMIT ISSUED...............................................................-.........................1.........-• DATE.......•.... ......-...........__...- ._......... <br /> Alterations and/or recommendations:............................................._. -.-•"---,........-----"------....-•----.-.._............`..-•----•--•- ._.........._...... u'P. <br /> T-"---"••--•----------•----•-----".._..---"--"--------------------"---"-----""•----"----•--. <br /> __._..1 ------- ............................-"--"-----•............."•-"•---------"--------__....._._._..--•---. ........... <br /> �. <br /> FINAL INSPECTION BY:. . )J< <br /> .._.. ---•-•-----•-- Date-- --- //......... _.." -"---" <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hknelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.Cp- <br />