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FOR OFFICE USE: <br /> ------------------------------------------ ---------- ^ <br /> --------------------------------------------------------- <br /> APPLICATION FOR-SANIYATION PERMIT Permit No. <br /> -------- -- ----------------------- ------------- (Complete in Duplicate) r <br /> - 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..t� <br /> JOB ADDRESS AND LOCATION -----:?'- ,- <br /> Owner s Name --- �__! � CiJ-' r' <br /> - ----------------------------------= <br /> ------ Phor'ie-- - ------- ----------------- <br /> Address------- ---40-x � Q----------------- --- -- -� ;?------------------------------- ----------------------------------------- --------••-------------------------------._.. <br /> Contractor's Name------ le­ <br /> Phone-•-----•--------------------------- <br /> Installation will serve: R ❑ Apartment House ❑ Commercial ❑ Trailer Court Motel ❑ Other ❑ <br /> Number of living units: -------- Number of bedrooms -Y Number of baths -------- Lot size ----- ---J- 7-9---__.__-___.--- <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -/0_ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [❑ Clay ❑ Adobex Hardpan C]Previous Application Made: Ilf yes,date--------------- ----I No 10__ New Constructions Yes ElNo P� —FHA/VA: Yes F] NoV <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 204 feet.) <br /> Septic Tank: Distance from nearest well-----------------Distance from <br /> / - -_. foundation-.----_-----.-r"r.Material----.----.-.---.------------------------- <br /> .-.---_- <br /> t No. of compartments Size ----..------------------------ iquept 's Capacity----------.- <br /> Disposal .!. <br /> 'i id: Distance from nearest well---4-0 from foundati���-)---'--.Distance to nearest lotlipe- <br /> Number of lines--- ------ -- ...-__ Length of each line_ _...--- --- Width of trench___ ._+�_,_._ <br /> Type of filter material.—7_��-_1�..pepth of filter material---.----�fr.-I-_Total length-.-.---.- �1---- -------------- <br /> tl 'i <br /> eepage Pit: Distance to nearest well---------------------- from,,oundation__--------�-----_-.Distance to nearest lot line".----------___.. <br /> ❑ Number of;pits----------------------Lining material--------------------- Size: Diameter',,-------------------Depth--------------------------------- <br /> Cesspool: Distance from nearest well_- -ri'Distance`frbm foundation_-_--.. ...... "__.Lining <br /> - _ - Fm. aterial- <br /> -------- ---------------_----_ <br /> ❑ Size: Diameter------ ------------- ---------.De th----------------------------- - --' Liquid,Capacity--------- <br /> gals. <br /> Privy: Distance from nearest well.... Distance..from nearest building_---_----._-- ------------------ � <br /> ❑ Distance to nearest lot line- ----- -------------------------------------------------------------- ------------•----•----- --------- ------------------6.4; <br /> Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------------ <br /> I I <br /> 1 t 1 <br /> -------------------------------------------------- -----------------------------------------------------•--•---------------------------•----------------------------- ------------------- <br /> i 11 9 <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 'u 's and regulations of the San Joaquin Luca{ Health District. <br /> (Signed)-- .__7t A ---------- ------------------------- ---- -------(Owner and/or Contractor) <br /> By:-------------------•--•--------------------------------------------- ----------- ----------------------------------------------(Title)-----------A---------------------------- ---------------------- <br /> (Plot <br /> -- - ---------------- <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 ------- -----=------------------ ------ ----- DATE-------------------------- , ----------- --- <br /> REVIEWEDBY- ACCEPTED-BY------------------- --------------------------=---- ----------------- DATE lr.� ---------------------------------- <br /> BUILDING <br /> ------------------------------ <br /> BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------- ------ DATE-------------------------------------- ---------------------- <br /> Alterationsand/or recommendations---------------------------------------- ------- ---------•-------------------------•------------------------•----•------ •----- ------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> FINAL INSPECTION' BY-- ----------------- [.. '- Yt.=------- Date......./........L ---------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 west oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F,P.E o. <br />