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1LL_ Uor: <br /> -------------------------------------------------------- 4 <br /> --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> ---------- ---------------------------------------- (Complete in Dupli' to) <br /> --- ---------- ca <br /> ------------------- - This Permit Expires 1 Year From Late Issued <br /> Data Issued _J5----- 2__*_:,�� <br /> Application is hereby made to the San Joaquin Local Hea)fh District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County OrjinGe-,No,1549,� <br /> JOB ADDRESS AAD LOCATION/ Mi A� V - C', 4j,)ZP <br /> /T 6nd_V_W7-1- x —Oro-3�1 <br /> Owner* - ----------- <br /> s Name_ ZA, 44 ! - 0------------------------------------------ <br /> -------- -------- ------------------- ------------------------------------------- Phone-------------- <br /> Address ---------_----------- <br /> -1---------- ------ <br /> Contractor's Name----- ---------*-------*--------------------------------------------------------------------------------------- <br /> -------- ------------------------ --------------------------------------- ------ Phone__ <br /> Installation will serve:. Residence f'Hous <br /> Apartmen I "e 0' ----------------------------- <br /> l, Commercial El Trailer Court 0 Motel F <br /> I _] Other <br /> Number of living units: ­;'­—Number of bedrooms Number�oaths -------- Lot size _________________________- <br /> Water 0_dLiq,. <br /> Supply: Publi I - 7_%—------------------- <br /> C system 0 Community system D Private [V <br /> Character of soil to I -J' Depth 0 ter Table -------- ft. <br /> a depth of 3 feet: Sand [I 'Gravel F] Sandy Loam ��Clay Loam E] Clay El Adobe 0 Hardpan Ej J6.- <br /> Previous Application Made: (If yes,date--- No ❑ New Construction: Yes El No ❑[] FHA/VA.- Yes 0 No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool p;rmiffed if public sewer is available within 200 feet.) <br /> -septic Tank: Distance from nearest well-__________..__Distance from foundation---------- i <br /> I <br /> El No. of compartments----------- ......... Material-------------- <br /> ------------------- <br /> Msposai,posla: Distance from nearest weil ---------------Size--- <br /> -----------------------------Liquid depth-------------------------- <br /> Distance from founda' f ion--.-,?AP_.1 <br /> Number of lines__� / ---------Distance to nearest lot line,---4---------- <br /> Type of filter m6t:erial------ --- ----Length of each line----- --------------Width of trench--_-3,--------------------------- <br /> -----------------Depth of fi)fer material-------- length----,/ <br /> 1 47,5?---------------------------- <br /> Seepage Pit: Distance to nearest well__..__---_------------Distance from foundation__-____ <br /> --_Distance to nearest lot line <br /> El Number of pits----------------------Lining- material------._-----_._ ---.Size: Diameter------------- ---------Depth--------- ----------- <br /> Diameter---- I <br /> Cesspool: Distance from nearest well---------------.-D' tance from foundation---------- ---------Lining material------------------------ <br /> ❑ Size ­-------------------------------Depth----------------------- ---- - ---------- <br /> ------------------------------Depth-------------------------------------------------_Liquid Capacity-- ----- - ----------I <br /> Privy: Distance from ne --------- 5! <br /> -----------gal . <br /> esf well_____..._­r--------------------- ----------------Distance from nearest buildin❑ ----------------------------- <br /> Distance to neares f lot line-------- ---------- g <br /> ------- <br /> Remodeling and/or repairing (describe):__-___._____- . " <br /> ----------------------------------------------------------------I ------------ -----------------------------------•--•- I, <br /> ------------------------------------------------------------------- <br /> -- -------------------------------------------------------------I------- ------------------------------------------------------------- -------------------------------- ------ ----------------------------I-----­1------ <br /> .1----------------------------------------------------------------I---------------------------------------------------- -------------------------------------- <br /> -----------------------------------------------------------------I-------------------------------------------I---------------------------------------------:------ ------------------------------------------------------------ <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 a s, and rules and ;regulations of the San Joaquin Local Health District. <br /> (Signed)--------- <br /> ---- ------------------ .. ..... <br /> ------------------ ---------- -------------------------- ----------115AIND-P,--and/or Contractor) <br /> By:------------------ ------- ------ ------ - ---- -- --- --- - -------- (Title]le)---- ------- <br /> --------------------------------------------------------- ---------- ........ <br /> (Plot Plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse---side]. <br /> --------- <br /> a Ls, and <br /> . ..... ... <br /> ....... .... . .. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------- . ,T <br /> REVIEWED BY ---------- DATE------ <br /> ..................................... <br /> BUILDING PERMIT ISSUED I------------------------------------------- -------------------------------------- DATE------------------------------------------------------------ <br /> Alterations and/or recommendations:_--I---------------------------------------------------------------------------------- DATE.----------------------------------------------------------- - <br /> ----------- ----------------- -------------------------------- ------------- -------- ---------------------------------------------------------------------------------------------------------------------------------- <br /> ­ -------------------- -------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------- ----------------------------------------------------------------------------------------------- <br /> ------------------ ---------------- -------------I :­-------------------------------------------------------- -------- <br /> ------------- ......... ........ ------------------- ---------------- ------------------ -------------------------------------- ----------------------------------------------- -------------------------- <br /> ---------- ------------------------------------------ -------------------------------- ------------------------------------------------------------ <br /> FINAL INSPECTION BY:... <br /> ------------------- Date_ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore street 205 West 9th Street <br /> Stockton,California J Lodi',California Manteca,California Tracy,California <br /> Z— <br />