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FOR OFFICE USE: 1 <br /> Is -4 - <br /> Permit No. �01�__` <br /> b `— � APPLICATION FOR SANITATION PERMIT ........... <br /> '" {Complete in Duplicate) `3�y�y � <br /> . . m ipiFW' . -�_ _ Date...lssued.,. <br /> ----------------"-__--------- ____---_.-_ """This Permit Ex Tres"1 Year From D'afelssuedJ' <br /> _ Application is herel �tade'to the San Joaquin Local Health District fora permit to construct end install the work herein described. 1 <br /> This application-is'made in compliance with County Qrdinan e No. 549. <br /> �.c r `c/C�- e.- -- <br /> JOB ADDRESS AND LOCATION----------�a--z---1----------------`' -------- --- -- --------------- ------------------------------------------------------------------------- <br /> ? <br /> Owners Name- -•----- -�:I`�:`�----=---(_Cl..vs_fa_�/`C- �-----•--•-----=. - - ------------------------------------------- Ph --- •- -- -----------•-•-------- <br /> Address--------' --- :.:_-_- — --_=__ = _._—.... ; <br /> Contractor's Name-------���:6,c--�-- Y --------- --------------- ----------- ? ------------ -------------- <br /> Installation <br /> ----------•-Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Mote! ❑ Other a <br /> Number of living units: __1----- Number of bedrooms -------- Number of baths _1____- Lot size <br /> ;-_ --------------=-------------------- a <br /> Water Su I Public-s"stem_.. Communit system Private Depth to Water Table � eft. <br /> PP Y Y Y Y ❑ p 5 - <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy: l_oar'r� ❑ Clay 'Loam Clay E] Adobe ❑ Hardpan ❑,• [ <br /> t <br /> Previous Application Made: (If yes,date: *..-:.__.----) No R- New Construction: Yes ❑ No E FHA/VA: Yes ❑ No <br /> TYPE SOF INSTALLATION AND SPECIFICATIONS: i._.._ ^ ��_ � . <br /> C <br /> (No septic tank or cesspool permitted if.public sewer..is available within 200 feet: <br /> Septic.Tank: Distance from nearest well__ 5--. - Distance from foundatio -_/_ ___p.____ :_.___.__ <br /> k � <br /> No. of compartments____ '�____________ _Size__YX.f ___,___LiquidX_9_� de th____._y-..___.______..Capacity__JAkl u i <br /> Field: Distance from nearest well_- `..........Distance from foundation--------------------` Distance to nearest lot line--- <br /> Disposal <br /> ❑,/ Number of lines___.____Z----------------__---Length of each line_-i-�'�'-` - °_F.._.Width of trench____.Z_`__._______-__________ <br /> t Type of filter material___.OR�zc_A......Depth of filter material____ ..8 .............Tota! length-----/_r__0_/------------------------ LA <br /> O° i <br /> Se °---•----:Distance to nearest lot line---- .. ___.___ <br /> V 1 <br /> epage Pit: Distance to nearest well___/..___----______Distance from foundation__"�__ <br /> �[9- Number of pits-------�-r_----_---- Lining material_-�f_► q#. -.k-.--Size: Diamete r__--,��-��-------.Depth_...2-r57­1------------------- � <br /> Cesspool: Distance from nearest we!l------------_----Distance from foundation-_._,_. '__-_ 'Lining material______..____------.________________- ! <br /> Size: Diameter--•------ ------------------- ------Depth------------------------------ - -------------Liquid Capacity---------------------------gal <br /> Privy:) `Distance from nearest well----------•--------------------------------------Distance from nearest building----------------------------------------- <br /> ..r = 1 <br /> ❑ Distance to nearest lot line -- -------�--i-------------- - <br /> - <br /> g repairing (describe): , <br /> ------ -•---- ------------------------------ <br /> r --------------- <br /> Remodelingand/or re ainn ------------ -- - ---------=_=°_------------------------------------------------------------------------------------------------------------------ "1 <br /> - -- - <br /> ------------- ---------------------- ----------------------- = ----------------------------------------------------------------=------- ----'---------------------------------------------------- <br /> I'hereby certify that I have prepared-this application avid that f the work will-Ke done in accordance with San Joaquin County.� <br /> Fordinances, State laws, anA. rules and regulations of the S Joaquin Local Health District. ' <br /> t ; � <br /> - 1� --------j-------------- --------------------------- Owner and/o Contractor) <br /> (Signed) - --------- --------f <br /> BY:--------------- --------------------------------.--(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 DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY DATE---- �� ��----------- -------------- <br /> REVIEWEDBY------------------------------- --------------------------------------------------------------------- DATE----- --------------------------------------------------- <br /> BUILDINGPERMIT ISSUED----------=-- ----- f------------------ ------------ DATE--------------_------ ------------------------------------ <br /> ` _ <br /> Alterations and/or recommendations:--- __-� - = <br /> ' l - <br /> •-/�— `f <br /> ----------------------------- <br /> ------- --- ----------- - ------------------------ - -------------- -------------- --- -------------------------------------------------- -•--------------- <br /> E <br /> FINAL'INSPECTfON"BY::4-e----.....�GEr�---- Date- � � ----- ----- :--- ------ --------------------- --------------- <br /> SAN <br /> ---------- -SAN JOAQUIN LOG L HEALTH DISTRICT <br /> 1601 E.Hazollon Av&. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,CaliforniaManleca,'California _ Tracy,California <br /> Spee lba� 'f <br /> F.P.c o. . <br />