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FOR OFFICE USE: <br /> ------------------------------------------------------ <br /> APPLICATION FOR SANITATION PERMIT Permit No. A"_�' <br /> ----------- ------------------------------------------- (Complete in Duplicate) <br /> -. <br /> -----------------------------------------_.........____ j This Permit Expires 1 Year From Date Issued Date Issued1-'- -- ----: <br /> Application is hereby made to the San Joaquin Local Healfh 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 LOCATION_Ir__ 1llY___ 1 _I ;l_ __ ?*.. <br /> � % <br /> Owner's Name-----------[-[ fqabi4w)-=-------------------------------- Phone------__ ---------------- <br /> AddreAddress----------------------- <br /> ss------------------------- t-----•-9)_ --------------------------------------------------------------...-----------•---•-----------------------------.----. <br /> Contractor's Name----------------------- <br /> ---------------- 12]C�-ew-------------- ----=---�I_S_�o`2------�_-�//�:�-�-------- Phone.93_;k._.S_6.fa'�------- <br /> Installation will serve: Residence Apartment House.❑p�ryry Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ___-_.Number of bedrooms __eG__ Number of baths 1_-_- Lot size -----424--^------------------------ ------------------ <br /> Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Tab4e _112 ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[Hardpan ❑ 1 <br /> Previous Application Made- [If yes,dote-------_-----------) No Er- New Construction: Yes ❑ No Z" FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: Ilk 1,0, <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well._.__Distance from foundation-_/O______-.__.Material__/ _e._ s _5�_______________________ <br /> No. of compartments----------Q------------Size_a' �`_.16__�`__� _.Liquid depth_-_-_- - -------- <br /> Disposal Field: Distance from nearest well..._._Distance from foundation---l4-------------Distance to nearest lot <br /> Number of linesa__t_______ __ Length of each line--------80_------------_ Width of trench_._.__�_ ._______._.______ <br /> ---------------------- � <br /> Type of filter meri ______________----- 1­0al__ 4P De th of filter material__ . _ .�__......Total len th----_-__1- . __ <br /> Seepage Pit: Distance to nearest well-----------------------Distance from foundation--------------------Distance to nearest lot line-_.__--._________ <br /> ❑ Number of pits---------------------Lining material-----------------------Size: Diameter----.------------.----Depth_.-------------.----------------- t <br /> Cesspool: Distance from nearest well-----------------Distance from foundation__-----------------Lining material____.___---__.._-__.____-_---------. <br /> ❑ Size: Diameter-- ---- - - Depth --------- - ---------- - --------Liquid Capacity--------------- ----•-- gals. <br /> �_- �- <br /> Priv D isT#anc� from nearest well_ Distance from nearest buildin <br /> Privy: g------------ ----- - - - <br /> ❑ Distance to nearest lot lime--------------------------------------------------------------- ------ -------------------------------------------------------------------- <br /> ( <br /> Remodeling and/or repairing (describe):------- -------------------------------------•--•-----•-----------•----------------------------------------•----•----------------------------------- <br /> I _ <br /> ----=--------------------------------------------------------- - <br /> --------- ---------------------•------------•---------------------------------------------------------------------------------------------I--------------- <br /> i <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County I <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> ned L 1 <br /> (Si 9 } � ------------------------------------------------------------ -------(Owner and/or Contractor) <br /> By:---------- ------ <br /> ----=--------------------------------------------------------------------------------------(Title)----------------- ------------ ....... <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 B DATE------.��__°99.77&--£S------ -----------------: <br /> REVIEWED BY----------- DATE---------------------- -------------------- <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------- ------------------------------------------ DATE----------------------- ----------------------------------- <br /> Alterations and/or recommendations:---------------------------------------------------------------/-------------------------------------------=---------------------------------.-------- I' <br /> -------•------------------------------------------------------------------- -------------------------------------------- ----------------------------------------------------- -------------------------------••------------ <br /> I -------------------------------------------------------- --------------- ----------- -------------------------- -------------------------------------- <br /> - <br /> ------------------------------------------- - --- R:---------------- ----- ---------- --------- ---- --------------------------------------------------------------------- -------------------------------------- <br /> FINAL INSPECTION"'BY -Y � -?--------- . - ----------- <br /> - --------- - -- Date - -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street \ <br /> Lodi,California Manteca,California <br /> Slocklon,California #` Tracy,California <br />