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FOR OFFICE USE: <br /> ------------------ <br /> APPLICATION FOR SANITATION PERMIT Permit No. ... ...... ........ <br /> ------------- ------------------------- (Complete in Date issued <br /> Duplicate) <br /> � ----- -- ----- � -----,-----�------ <br /> -------------------------- --------------------- This Permit Expires 1 Year From Date Issued <br /> Application i is hereby made to the San Joaquin Local Health District for a permit to construct and instal[the work herein descri}aed` <br /> 1 This application is made in compliance with County Ordinance;No. 549. E <br /> I <br /> t <br /> i t ••. r f v -- ---- <br /> 91 <br /> JOB ADDRESS AMDOCATION--- _--..'�" .--w --- ._..- -!`.-'G---- - <br /> Owner's Name -- -� .'.- --- Ph <br /> Address...... 0 R------- ••.... ----• ----- ------------------ -•--T- �,----- <br /> !.� one r-------- <br /> Contractor 1 <br /> s Name - --------------- Phone <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ; <br /> Number of living units: _ Number of bedrooms _ �Number of baths _ Lot size --___ ►$_ _ <br /> 1 <br /> i r".-, � <br /> Water Supply: Public system El Community system ❑ Private Depth to Water Table ---.---- ft. <br /> Character of soil-to a depth of 3 feet: Sand E] Gravel E] Sandy Loam [Clay Loam E] "Clay C] Adobe ❑ Hardpan E] <br /> i 'Previous Application Made: (If yes,dote--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No 0 <br /> -•-" TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tankroricesspool permitted if public sewer is available within 200 feet.) <br /> P � `Liquid depth ,�� ----------- Capacity-;/ 'p- -- <br /> �V Distance from nearest well--.S ---_..--Distant fro foundation--------- ----- --Material-.-. .e -------_.� <br /> Septic ankle ( No. off compartments _ -__ <br /> ld: Distance from nearest well---- Distance from foundation.---10..........Distance to nearest lof)ine-- ----------- <br /> Dispos 1e Number of lines_-_-------_, - -----_---_- Length of each line-_- -----------------Width of french---y-___ <br /> t G ++` <br /> Type.r of filter' material._-_- --------Depth of filter material------t!!.-----.__Total length----, ------ --------------__-_-- <br /> Seepage Pit: Distance to nearest well-.---_---------------Distance from foundation--------------------Distance to nearest lot line----------------- <br /> NumbeNum _. <br /> r of pits----------------------Lining. material Diameter -.-_.-.-------------.Depth--------------------------- -.-• <br /> 61A I <br /> Cesspool. x Distafice from nearest well_.------_----_-Distance from foundation-------------_----.Lining material-------------------------------------- <br /> ❑ 1 Size: 'lameter----------------------------- -------Depth----------------------------------------------------Liquid Capacity---------------------- -----gals. <br /> --____-___Distance from nearest building--------.------------------------------ <br /> Privy: Distance from nearest well-------------_.---_------------.... <br /> Distanceto nearest lot line--------------- ------------------ -----------------------------•-------------------------------------------------------------------------- - <br /> Remodeling and/or repairing (describe)------------------------ <br /> r.. <br /> ' .1 :'y ------------------------- <br /> - <br /> .----------------- -----------------------=---•--------------�-�`:_..----------------•_-`--------------------------=-------•_-------=-•--'------•---------------'�-----•---------- .-....__ <br /> .f E i -- i <br /> t fi <br /> I hereby certify that I have prepared this application'�and-that the work will be dane'in•accordance with San Joaquin County <br /> ordinances; State la , d rules and regulations of the San Joaquin Local Health District. - <br /> x 3I <br /> (Signed)..``== y' _ _:.,_ '._ ... = =._---= - ��..and/or -crttetor) <br /> :showin size of lot location of system.in relation to ells, buildings, etc., can be la(ced.on reverse side. <br /> - Title-------------------------- <br /> ------------- <br /> By:=F-- - - (Title) ; <br /> (Plot plan, � g9 P � <br /> = FOR DEPARTMENT USE ONLY - t <br /> APPLICATION ACCEPTED BY ------------- ---------------------------------- DATE "l`= ------------------------- <br /> REVIEWED BY--------------------------------------------- <br /> ------------ ------------------------------------------•-------------------` DATE--------------------•--------- ---------------------------- <br /> Ds PERMIT ISSUED + - DATE ---- ---- <br /> and/or recommendations:----`-- ------�2.��,.Z-- ---- -- __,14.�--- -- <br /> AlterationsWe <br /> � f/'""�-•..�ix-�. ._ <br /> ------------------- -------- <br /> - ----•------•----- f--. <br /> / '� <br /> ( -------------: ---------------------- -------------------------------------••-----------------------=------- -•----------------------------------------------------------------------- <br /> P ' <br /> FINAL INSPECTION BY:-- --. ---------,, �r1��fiL----- ------•----- <br /> ' Da+e.__ .-_/. -'� ----------- --------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxelton Ave. 300 West Oak Street # 124 Sycamore Street 205 West 9th Street <br /> x <br /> Slockton,California Lodi,California Manteca,California Tracy,California <br /> £S 9 REVl6ED.6-59 361 3-'63 C.P.CD. faa (3 •- <br />