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FOR OFFICE USE: <br /> ................... .................................... <br /> •--•------......-•-.:.................................. <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No. .o�fls�.:� _ <br /> -----....................•-------...........----......... (Complete in Duplicate) Date Issued <br /> ...._._.-•.................................. This Permit Expires 1 Year From 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 /> r o s3 ,,�,� <br /> JOB ADDRESS AND LOCATI N--_- .�..`�L.:r _F!4- - --------------•--.--_----.--•-.--------•---------------------- <br /> Owner's Name----------=- -4�_fr !.�4_._..._. '. ��_�a..................................................................... ...... Phone.... . - a.. 1 ... <br /> Address-------•-••----••- � k Q ..... ........................--.................................................................................................... <br /> Contractor's Name....... „td�;.�t�-*- ---...1 .._.-.L -'a.... .... Phone........................_...... <br /> ... <br /> Installation will serve: Residence 0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel El Other ❑ <br /> Number of living units: A.... Number of bedrooms ...�_ Number of baths .;? .. Lot size .L.. <br /> Water Supply: Public system ❑ Community system ❑ Private NJ Depth to Water Table ........ ft_ <br /> Character of soil to a depth of 3 feet: Sand❑ Gravel ❑ Sandy Loam ❑ Clay Loam[8L Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,dote...........,........) No Xr New Construction: Yes jE No [j FHA/VA: Yes ❑ NoV <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool Permitted if public fewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well.....A0./--_Distance from.foundation.._41P-_---...Mate�al... ............................... ........... <br /> No. of compartments....-...._2 ..-__._Size.._.f .... ..Liquid depth......'� ...........Capacity-.•f/_Q'�_.___ <br /> Disposal Field: Distance from nearest well-..�1XJ..__�5bil Iance from foundation....0..........Distance to nearest lot line....�.&...•.. <br /> ( Number of lines_...__.._.3...................Length of each line,; �.� -1t�7,(�vVidth of trench........ �.__..._.-- <br /> 7C Type of filter maferial.4h_-__Z0CK_Depth of filter material..--. .......Total length..........s. 2.................... <br /> Seepage Pit: Distance to nearest well......................Distance from foundation--------------------Distance to nearest lot iine........_........ <br /> ❑ Number of pits......................Lining material.......................Size: Diameter.......................Depth------..-----___------------- <br /> Cesspool: Distance from nearest well.................Distance from foundation....................Lining material................................................. <br /> ❑ Size: Diameter-------------•----------- ........Depth.•-.....----•------•---__.---------.............Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well.................................................Distance from nearest building........... ..............-.---...... <br /> ❑ Distance to nearest loft line............................................ ---•--------•-•----•---•--•------••-----------.......-•-•----•---.--....------................ <br /> Remodelingand/or repairing (describe):........._............................................................................................................................................. <br /> -•-••------••--•....•........................•---••---•••................................--...................•------••--•••----••------••----•-••--•----•-••-----••.............. <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, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> r <br /> l% ;\ � r <br /> Signed /.. ..... ------------------ ....................... -------------........(Owner and/or Contractor <br /> By: ... ...c................................... .............(Title)....................... <br /> ..G'7.��x�1t[/c.�- <br /> (Plot P 9 <br /> Pltan, showing size of lot, location of syste in lafion to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY................................................•-•------ --................................... DATE...-..---------------------------------------------------- <br /> REVIEWEDBY..........................................................._... ---.....•...................................•-----. DATE_.. <br /> BUILDING PERMIT ISSUED.................-------•-=------- ----•...................-•-......................_.............. <br /> DATE-----------------------•------------------------------------ <br /> Alterationsand/or recommendations:--------•--------------- ............................................................----------•------------------------------------------------ <br /> •.....:.......................••-•••--•....................................................-_..................•....-..................................................... <br /> ..--•-•..................................•------...----•---..........--........-----•-........................................................................................................................................ <br /> ...........-•..........................•--.......-•••---•••... -----•----*...... ..........-•--._........._................................--...................--••-•----• •..... <br /> FINAL INSPECTION BY:_ _----. Date ........... .. ­4.. � <br /> fQ� SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> t 1601 E.HavellioXVe. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> 5locklon,California Lodi,California Manteca,California Tracy,California <br /> [e 9 REVISED 0•69 9M 3-'63 F.P.DD. <br />