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FOR OFFICE USE: <br /> �. <br /> -------------- - - -- -- <br /> APPLICATION FOR SANITATION PERMIT Permit No. __...__p..._��`3.. <br /> ----------------------------------- --- ........... (Complete-in Duplicate) <br /> This Permit Expires 1 Year From Date Issued Date Issued �d <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 �O[rdinance No. 549. �` <br /> JOB ADDRESS AND LOCATION--N-9-41I 1-_`_b M e r `•`J- S.•6 CK-`--t <br /> Owner's Name ��--- .D_W......------CFV 1----5 S? k M 1.S S t o --- Phone i`�� <br /> 3l~ <br /> Address ` ........ { -----5------------------------------------------------------------- -------- <br /> Contractor's Name �aMf----------------------------------------------- Phone. <br /> Insfallation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel E❑ Other g <br /> Number of living units: .--- Number of bedrooms ....---- Number of baths--_---- Lot size _j��r---_1 s <br /> Water Supply: Public system ❑ Community system ;r Private ❑ Depth to Water Tablelo'- ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ® Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date...........,------- ) No ❑ New Construction: Yes [A No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 1. <br /> r <br /> (No septic tank or cesspool permitted if public sewer is available within 204 feet.) ` \, <br /> Septic Tank: Distance from nearest well7i3O-0..-Distance from foundation.___. P--------Material Cp +� s--- V <br /> ❑ No. of compartments---------- ,_.....Size------------------- -----------Liquid depth ----. ........Capacity----------------------- <br /> Disposal Field: Distance from nearest well-_>1�.5P..Distance from foundation.... -------..Distance to nearest lot line----------------- <br /> ❑ Number of lines ----------------------------------Length of each line._ _---.....____...._.___._-.Width of trench..------------------------ -------- <br /> Type of filter material-------------------------Depth of filter material----------- -----------Total length................_.-.....__--._--_---..__ <br /> Seepage Pit: Distance to nearest well------_---------------Distance from foundation------------------- Distance to nearest lot line............-.--- <br /> ❑ Number of pits---------------------Lining material---------------------- Size: Diameter------------------ ----Depth--------------------------------- <br /> Cesspool: Distance from nearest well _.----------_..Distance from foundation:-'1_..---- --- Lining material----------- <br /> Size: Diameter- -- --------- ----- ------ ---------Depth------- - ----- -...........-------------Liquid Capacity-.-------------------------gals. <br /> Privy: Distance from nearest well___---_---___-------------_----------------------Distance from nearest building------------------.------------..-.---_-- <br /> ❑ Distance to nearesf lot(kiine ------(--------------------------- <br /> .- ------------------------------------------------------ --�-`--o----M----_-.-_-.-C----1n----V----�--"--C---_ <br /> ------- <br /> Remodelin and/or repairing (describe):_. - fi '1e 0 , <br /> - ...�--.' . ---- <br /> -Tt a <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 /> Br----- -- #- -- -- 1 4S <br /> -�'-.��- ---- ----------------- �--------------------- ----------------- ----- - � ----(Title)----------. . <br /> (Plot plan, showing size of lot, locati of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY- ............�_. <br /> . __-.. .-- :----------------------------------------------------------- <br /> DATE I---- ------------------------------- <br /> REVIEWEDBY------------------------------- ------------ ------------------ - ----- -- -------------- ----- ------ DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED-------- ---------------------------------------------­ -------------------------------- ---- DATE---- ---------------------------------- <br /> Alterations and/or recommendations: ...................... ---- --------------------------------------------- ------------•--------------------------•----------------- <br /> --------------------------------- ................... -------- ------ -- - --- - ----------- - - ----------------------------------------•----------------------------------- ------------------------------------------- <br /> ------------------- ---------------------- - - - ---------------------------------- ----- - <br /> FINAL INSPECTION BY-It-111------`----- ----- Date. L�~ .. -------- =7------------------------------ <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 /> E.H.9 2M 1-67 Vanguard Press <br />