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IFOR OFFICE USE: <br /> -------------------------- <br /> IL _ M APPLICATION FOR SANITATION PERMIT Permit No. ... <br /> ------ -------------------------------------------------- (Complete in Duplicate) <br /> -----------------------------------------------------____ This Permit Expires 1 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. /� j• r �J��i <br /> JOB ADDRESS AND L CATION____ �----�-C--------�----`----�- _-�--------- r/ -------P-------------------------�-------� -- --n---/Z-/-- ------------ <br /> -�.- <br /> � <br /> Owner's Name �� -- _ �7•� [ ------------_ --------------------- ------------------ Phone_--- ----------- <br /> Address-.--- �... . } ��._ . ------ <br /> Contractor's Name----�. -- ___t__---------------------------------------------------------------------------------------- -- Phone...----------___.----_. <br /> Installation will serve: Residence Ej-_A_­partment House-E] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> ,,�= ------------------- <br /> Number of living units: __-�'__ Number of bedrooms --?- Number of baths --7--- <br /> 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 ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No a--IN_ew Construction: Yes Vj_-fq0 0 FNA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within�00 feet.) <br /> Septic Tank: Distance from nearest well__1C_?____Disfanc rom founnd�tion__.__/01 -n--- Materia___P- <br /> U111 -No. of compartments 7x -------Size- - __- :---Liquid de th-------- <br /> -- ---- C <br /> P / q P. P - <br /> Disposal Field: Distance from nearest well_,(_-d/___Distance from foundation_-_ Q�-------Distance to nearest lot Ijne___'S._..._____ r <br /> Number of lines______________�-_.---------Length of each line------- ---_______.Width of trench----------------------------------- 1n <br /> Type of filter material- - --_Depth of filter material___rJ__ ......Total length________ _______l-_-- <br /> Seepaggee Pit: Distance to nearest well _ ..___Distance from foundation____ _ ________Distance to nearest lot line�� <br /> Number of pits--------2--__.---_Lining material---A.r7_�-.Size: Diamefer___7�_�._.__Depth___._ `___ ✓l�' _ <br /> Cesspool: Distance from nearest well________________Distance from foundMion--------------------Lining material___.______.________.____._________.__. <br /> .❑ Size: Diameter--------------------------------------Depth---------------------------------- ----------------Liquid Capacity_..-------------------------gals. <br /> Priv Distance from nearest well______________________ Distance from nearest building 0 <br /> ❑ Distance to nearest lot line--------------- -------------------•------ ------------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe)--------------- ------------------------ ---------------------------------------------------------------------------------------•------------------------ <br /> ----------- -------------•---------------------------------------------------------------------------------------------------------------------------•-----------------•----------------------------------------------- <br /> -------------------------------------------------------------------- -------------------------------------- ----- <br /> I <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 /> , <br /> - e <br /> (Signed)- _ -------- -------------------------------- (Owner and/or Contractor) <br /> � 2 <br /> B 1 r Title <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed,on reverse side). <br /> r FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY------- ------- -- - ------------------------------------------------------------------------------------ ------DATE------------------------------------------------------------ <br /> BUILDING PERMIT ISSUED---------------'--------- <br /> ----------------- - -• t DATE. - <br /> Alterations and/or recommendations:___'_-_._ 2^ / -=t____�"` �-1 ``—_�__ __.._ '' '--z--.------C_ -.___._-Z---:_____ <br /> c� <br /> C f <br /> —T, a <br /> •c—- � --� cr"`T � -[.-cam <br /> �"�-c�--�' C ��--e iC 1. <br /> �= '�- ��- -------- ---�[.,--b �� -'�- - - -- �'C <br /> r j <br /> FINAL INSPECTION BY:----�C__..__r3000 <br /> �"-�--- '_.---- Date__�/ 1. ���' _- -- -- -- -- - - -- ----------------------------------- <br /> JOAQUIN LOCAL HEALTH DISTRICT1601 E.Ha:ellon Avt. st Oak Street 124 Sycamore Street 205 West 9Th Street <br /> Stockton,California California Manteca,carifornia Tracy,California <br /> 4' <br /> CS 9 gEVkS ED 8-59 3M 3-'63 F.P.0 D. =,a. <br /> L ' <br />