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- <br /> .._ APPLICATION FOR SANITATION PERMIT Permit No. .� �-�s <br /> .. . . .............................--. (Complete-in Duplicate) QQ <br /> Dote Issued T_-.. <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_maderin_compliance,with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION...)�OPG--....`Sl-PttJC� _...........................•----C)71-(1?c­oS <br /> - ---------------------- <br /> Owner's Name..-.}Pm kN1 -PG'C <br /> ------................................................•---------. .--------------••--... Phone------------------------------------ <br /> Address.. d_ c <br /> ............-•----------------------------------............................................................... <br /> Contractor's Name K l �> �- i4.l.i '� .Z-!\ -.. ........•----••--•- -• -•..................................... Phone...... ............................ <br /> Installation will serve: Residence Apartment House Commercial <br /> ❑ p ❑ ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: .. ..... Number of bedrooms ........ Nerlber of baths........ Lot size .._. _., <br /> Water Supply: Public system ❑ Community system [] Private ❑ Depth to Water Table ft <br /> Character of soil to a depth of 3 feet- Sand [3 Gravel ❑ Sandy Loam l] Clay Loam Cloy ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date__.. .............. ) No ❑ New Construction: Yes ❑ No ❑ FNA/VA: Yes ❑ No D <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 <br /> Septic Tank: Distance from nearest well.................Distance from foundation....................Material ..._ . ......_..._..____._.._._... _.-..: <br /> ❑ No. o= compartments.................... Size--- --------- ------ -----------Liquid depth......... ....... ........Capacity------------------_ _ <br /> Disposal Field: Distance from nearest wel).................Distance from foundation-----------.........Distance to nearest lot line.... <br /> ❑ Number of lines_--------------------- ......Length of each line._ ...........................Width of trench.--._._._----.-.-_-......_'' ` <br /> Type of fiber material-__--- ------------------Depth of filter material._._...._.....-..._. Total length------------------------_-------------- <br /> Seepage Pit: Distance to nearest well............._.____._Distance from foundation--------------------Distance to nearest lot line.................moi <br /> .� Number of pits.-. ..................Lining material.........._---------- Size: Diameter----------------------- Depth. ............................... <br /> Cesspool: Distance from nearest weN ................Distance from foundation_..---------.-... ..Lining material.........._.._..------------ <br /> ❑ Size: Diameter- -- -- - - � ---------- ---Depth..----......... •----........_...----------------..Liquid Capacity............................ <br /> gals. ' <br /> Privy: Distance from nearest well.- ..............................Distance from nearest building--__-_--.____.-----------------........... . <br /> ❑ Distance to nearest lot line - - <br /> ------------ r .� <br /> Remodeling and/or repairing (describe):. A _ ���� <br /> d- 1 ..ZZ ------------------- <br /> ----------------------------------- ------------------------------------ - --- <br /> ' `'`'' •�---.... ---------- ------------ <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 and regulations of the San Joaquin Local Health District. <br /> (Signed).............. . .-•-------------------------------------- ........... ......... ................................ -.............(Owner and/or Contractor) <br /> By:..................i------------- .......................... _ . ..................... .........._ ......-.................(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 Mi,-Vw M.� �-, �'' c�, DATE---- q.7.X-. <br /> _ .__._ <br /> REVIEWEDBY-----------------------_ -• -- ..------.-------•-----------•--------..._ ----- -------- ---- DATE---- -.. .... <br /> BUILDING PERMIT ISSUED........ ................................--------- ........................................ DATE........ . <br /> Alterations and/or recommendations:---------- ------ - ----- -- - ------------------ ----•- <br /> ----------------------- -----•------ -------- -- ------. ----- - ---------- <br /> ..................................................._. . . ------ ----- -------.....-----...------- ............................................................. .................. <br /> FINALINSPECTION BY:....................-.........- ----- -------------------- Date............................................. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazolton Avis. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br />