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FOR OFFICE USE:. <br /> _____________________--.-__ ------------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> --------------------------------------------- --------- (Complete-in Duplicate) <br /> Date issued <br /> ..........................._.--.--_ -------------- This Permit Expires i 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 /> JOB ADDRESS AND LOCATION....__-� } �-----S` O AR4�-� <br /> Owner's Name-L� ._-....._�7A -tj� --- --- --------------- Phone <br /> -------------- <br /> Address--------iZ7Q5�----�------Kn_,'H_�R'�N_.F- <br /> Contractor's Name----O_W_A E�P;-- ---•---------------------------------------------- ------- -------- --------------------- ---------------- Phone.----- •------ <br /> 1 <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __/---- Number of bedrooms.3-.-- Number of baths-;?---Lot size - Q -- ' " <br /> Water Supply: Public system ❑ Community system ❑ Private(n"`Depth t -Water Table 3t . <br /> Character of soil to a depth of 3 feet- Sand [:] Gravel L] Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan <br /> Previous Application Made: (If yes,date_------------ -_ ) No New Construction- Yes R�-No ❑ FHA/VA: Yes 2---'No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <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----------K)_Material .COIV R ------------ <br /> No. of compartments---_... ------------Size__yX1Q-X--':__.Liquid depth---'—/ -------.Capacity-_f4OQ---- <br /> Disposal Field: Distance from nearest well----5C0-----Distance from foundation----/_p--------.Distance to nearest lot line----�.._._---- <br /> Li__ Number of lines---_--- g �..� <br /> _ _________________Length of each line_- --_ -._Q.__`--__-__-_..Width of trench- --_°Z -'_----_ <br /> Type of filter material---R_ .0 Depth of filter material-----je/_R- ---Total length--------------- PQ-------------- <br /> -- ` <br /> Seepage Pit: Distance to nearest well...__/.-V-Q------Distance from foundation----J0........ Dist an e to nearest lot li <br /> [�� Number of pits.-- . -_..-.-.-.Lining material-- 4CK___-- Size: Diameter__ X-�S.-...___Depth-.-.../�---.------ <br /> Cesspool: Distance from nearest well ----------------Distance from foundation----------.------ -.Lining material------------------------------------- <br /> F-1 Size: Diameter- -- --------- ----- --------------- Depth----•--------- ------------- - - - ---------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well----...............------------------------------Distance from nearest building----.-----.- ___------..------. <br /> ❑ Distance to nearest lot line------------------------------- ----------------------------------------------------------------------- <br /> Remodeling and/or repairing (descri�e]..-.--- !T C !__-LLnim____NC1(-[-___"f?D_-.�RR��-Z?-----_�-_.- <br /> --------------•-Rocjc. RAa---- ---------------- <br /> 1-1 �i ' - IQcK7 -L.IrN E1f'PAt[ D <br /> ---------------------------- ------------------------------------------------------------------- --r.-. <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, ate laws, and rul . a d regulations of the San Joaquin Local Health District. <br /> (Signed) / <br /> l (-- --- (Owner and/or Contractor] <br /> -- - --- --� - i <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 DEP `RTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- ------ ---------- ------------------------------------------------ DATE----I0----Jl� x <br /> - - ------------------- <br /> REVIEWEDBY------------------------- --------- ---- - - ---- - ----- ------------------------------------------------------------------• DATE------------------------- --------------------------- <br /> BUILDING PERMIT ISSUED------- -------- ----------------------------------------------------------------------- - ------- DATE------------------------ <br /> Alterations and/or recommendations:-------------------------- ---- - -- --- -- - --- ------- --- -------------��------------------------ -------------------- ----------- ----------------- <br /> ----------------- <br /> ------------- ------------------------ -------------•--------------------- - -- ----------------- -----------•------------------------------• <br /> Z <br /> - - ---------- ------- ........................... -- ---- ---- ---- ---­................ <br /> � 11 <br /> FINAL INSPECTIO Date---._ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ha:elfon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi California Manteca,California <br /> Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br />