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-----------3-4pp-_1----- AOICATION FOR SANITATION PERIO Permit No. ..alzaa-46.1 <br /> V----------I----------------------------------I <br /> ............................... ............ (Complete in Duplicate) Issued Date Issued <br /> This Permit Expires 1 Year From Date <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 /> 1 <br /> JOBADDRESS AND ........................................................................................... <br /> Owner's Name7_-/J�------ - ---------------------------------------------- ------------------------------------------ Phone.......... ................... <br /> Address"'-.d6!Alla: �_ .... .............. -------------- ----------_--.......................................... <br /> ................ ................ ------ --......................... <br /> r" -- <br /> Contractor's Nam .............. <br /> Phone..-............................... <br /> ............... . .. <br /> Installation will serve: Residence C] Apartment House E] Commercial ��Tr'a'iler Court [I Motel [I Other 0 <br /> Number of living units: _:Z.. Number of bedrooms J__ Number of baths -3... Lot size ........................................................... <br /> Wafer Supply: Public system 0 Community system E] Private 2T-Depth to Water Table .heft. <br /> Character of soil to a depth of 3 feet: Sand [] Gravel [I Sandy Loam El Clay Loam [I Clay El Adobe 2-19ardpan 11 <br /> Previous Application Made: (if yes,date-----------7--------) Non New Construction: Yes 0 No Rj­ FHA/VA: Yes E] No 0— <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 4 <br /> Septic amps Distance from nearest well---------------_Distance from foundation----------...-....Material------------------------------------------------- <br /> k� No. of compartments_.._- ---- ----------Size_--_-----_-----_----._Liquid clepth----_--------------------Capacity----------------------- <br /> Disposal Distance from nearest well-(........Distance from founclationZ.4.:............Distance to nearest lot line...41 <br /> ❑ej,,10( Number of lines...../...........................Length of each line...-6D..................Width of french-- 29- "----------_---­ <br /> ----- ;;---- IIj <br /> Type of filter materiaC�4.&-----Depth of filter material..../9-..`-..-----Total length............ --------- <br /> Seepage Pit: Distance to nearest ------------Distance from foundation--- ......... st ice to nearest lot line................. <br /> Number of pits ateri .1? .............. <br /> ­­---------------Lining m or__p.f �........Si__- - - -------------Depth.......VS.. <br /> Cesspool: Distance from nearest well.................Distance from foundation--------------------Lining material....... <br /> Size: Diameter------------------------------.....Depth-------------------------------------------.Liquid Capacity----------_-.......I.....gals. <br /> n <br /> Privy: Distance from nearest well..................-------------------------------Distance from nearest building........... ......I........... %> <br /> nDistance to nearest lot line._- '--- . ----------------------------------------------------------------------------------..................------------------- <br /> Remodeling and/or repairing (describe):................................. .........................................................__............................................... <br /> .............I.......11.........................I....I-----------­................................................................................................................................................... <br /> -----------_-----.........................................­­..................................................................................-------------------------.......................................... <br /> ------------ ---------------------------I................................................................I..............I--------------------------------------------------------------------------------------nt--- <br /> I hereby certify that I have prepared fhis application and that the work will be done in accordance with San Joaquin Couy <br /> ordinances, State laws. and rules and requlatigns of the San Joaquin Local Health District. <br /> (Signed)......----------y.. ---- -------------- ------ ----------------.................I—------_-_------------------(Owner and/or Contractor) <br /> BY:---------...............................-----------------------------------------------------------_----------------------_[*ritle)--------------------------- <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.---.......2� b/ ......................... <br /> REVIEWEDBY--------------_------.....---...-- ....... -------------------------------------------------............................. DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED-----------'-----'-............................ ...----•-----'---......---'---.........._. DATE....... ........................ .....................Alterations and/or recommendations:-- -----------......---'-------`............................................................. ...................................... <br /> ...........I..............................................................­............................................-------......................................................---­.......................... <br /> ...............................................I.............I........................-..................................................-..................... ................................................. <br /> ............... ...................................................................................._......................................................................------------------------------------- <br /> ----------- ------------------------ ..........................................................---------------------------------------------........................................­­---------------------.......... <br /> --- <br /> ---- <br /> FINAL INSPECTION BY:---- ----------�C_ -- ----­_ - Date.- ._/------------- ------------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br />