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F R OFFICE USE; <br /> -7------------------.lQ�: /��� <br /> ?ria_{ APPLICATION FOR SANITATION PERMIT Permit No_ _______________ ____ <br /> -- ---------------/`3d_-.T- (Com late in Duplicate) <br /> �... ...w. P. P ) <br /> This Permit Expires l Year From Date Issued 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 <br /> LOCATIO�!__4� _b-a--- ------------------------------------------------------------------------------------------------------ <br /> Owner's Name__=__/lye-------// 4- ---------------------------f-----••-------------------------------------------------------------- Phone <br /> Address --------------------------••-----------------------------------------------------•---------------------------------•----•------------- ------------------- <br /> Cortractor'.s Name. 7�--- --------------------------------- -------------------- ----- Phone <br /> Installation will serve: Residence Fr Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ElOther [I <br /> Number of living units: __.4--- Number of bedrooms __2- Number of baths -1----- Lot size -----— ---. . -____________________________ <br /> Water Supply:_ Public system 9?-community system ❑ Private ❑ Depth to Water Table _j6v, ft. <br /> Character of soil to a depth of 3 feet:- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe P3--ffardpan ❑ <br /> Previous Application Made: {lf yes,date___- <br /> ._--1 No [2K New Construction: Yes El No FHA/VA: Yes [I No <br /> . ; <br /> TYPE 'OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Talk: Distance from nearest well__` --___Distance from foundation fQ-------------Mate al______ <br /> No. of compartments____0—---------------Size----- Liquid depth-----�---------------- <br /> Capacity____ Oa.� <br /> Disposal . ield: Distance frommearest well_-'___...__Distance from foundation__j4p----------Distance to nearest lot line__________- <br /> Number of ------------------------ <br /> ...,,. x lines___ _1__ r - - <br /> Width of french <br /> A dType of filter material-__ Xg —____- epoferml-_ �'-- ---- ----- __---:_- <br /> R 41 <br /> Seepage it: Distancb.to.nearest well._.______________ Distance�ipm foundation--- 0-----------Distance to nearest one__A7___--- <br /> Number of pits______--------------Lining Size: Diameter____- .� ----Depth- .. <br /> (►�_�a <br /> •�'�--�----------------- <br /> Cesspool: Distance from nearest well----------------- from foundation.__ l- _ _ <br /> ----------------Lining materia ...-_____---_--.__._____ __ ______. <br /> ❑ Size: Diameter-----'---------- --------- ----------Depth--------------------------------- ---------------Liquid Capacity---------------------------•gals. <br /> Privy: Distance from nearest well----- ------ ---------------------------- --Distance from nearest building ------ --------------------------- <br /> Distance <br /> --------------- ----------Distance to nearest lot line------ -----------------------j----- ,:------- ------------------------------------------------------------------------------- ---------------- <br /> Remodeling and/or repairing (describe)------------- ---- -----------------------------------------------------------------------------•-------------------------------------------------------- <br /> 1 <br /> --------------------------------------------------•----------------------------------------------- <br /> t ------------ <br /> f <br /> i_____a_____________________----------------------------------------------------------------------------------------------------------------------------------------------------------___________ <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 gulati s o the S Joaquin Local Health District. <br /> (Signed)----------------------------------- - ------------------------------ ------------------------------ -------------------------------------------------(Owner and/or Contractor) <br /> Y� Title <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> i <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- - r---- ------ ----------------------------------------------------------- DATE ___r0K7----------------------- <br /> REVIEWEDBY--------------------------------------------- ----- ------------------------ ---------------------------------------------- DATE--.-- .----------------------------------------------------- e <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE----------------------------------------------------------- <br /> AlWns' a /or r commendations:._. <br /> ----- -------------------------- ----------------------------------------------------------------------- <br /> ---- <br /> ------ ------------------- - ---- - --------------- ---- ------------------ ---------- ------------------ - <br /> FINAL INSPECTION BY:----------- �-------- --------------------------- Date -~ -6 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. t 300 West oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,Califomia Lodi,California Manteca,California Tracy,California <br />