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FOR OFFICE USE: <br /> � .. '~ Permit No. ..�-`3I <br /> ------- - -- o APPLICATION FOR SANITATION PERMIT <br />- --� - ' = -- -i3 - <br /> ---------- (Complete in Duplicate) Date Issued ----------------- <br /> This Permit Expires 1 Year From Date Issued <br /> I Health District for a permit to construct and iinstall the work herein described. <br /> Application is hereby made to the San Joaquin.Loca <br /> This application is made in compliance with County Ordinance No. 549. OF <br /> JOB ADDRESS AND LOCATION-A"P'QO-X--I""�--[Ni�L�°------S�i1tc�; P-F- �t_N��N =c-Cgt"�7'S---D� IA�1+C7`L�/t/� <br /> t '`— ----------- <br /> 1 ----------• --- Phone <br /> 8A <br /> Owner's Name--------------V-k1---r----���. �- ------=----- ----- -- --------- --- ---------------- - - <br /> 1 x--- � /�� =----- -.5-1-r/,,-_v-� ��_ -----------------­----------- <br /> Address <br /> -------•------------------------ ,�/ r <br /> ° f� 1� d.-�- -. lV47 <br /> s = Phone- �n -• <br /> Contractor's Name-------------D"""- ` <br /> + Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> J --: Number of bedrooms " _._ Number of baths __ Lot size "_ <br /> j Number of living units: __ -_ <br /> Water Supply: Public system ❑ Community system.❑ Private Depth to Water Table :JS_ ft. . , <br /> i Character of soil to a depth of 3 fest Sand ❑ Gravel F1 Sandy Loam ElClay Loam 0 Clay E] Adobe❑ Hardpan <br /> ate-- -------------- -} Nog New Construction: Yes ❑ No FHA/VA: Yes ❑ No <br /> X <br /> Previous Application Made: (If yes,d <br /> } <br /> 4 TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within'200 feet.) <br /> Septic Tank: Distance from nearest well-.-------__-----Distance from foundafion-------------'----Material-------.__--.-.-""-_-__""-- _-.... __---".. <br /> ., -Capacity---------------------- <br /> k .' e from nearest <br /> --- --------- ----- Size-----------------------•- Liquid depth-- <br /> , [ S ia1C' No. of tom art I I Distance from foundation-_ _ ---------Distance to nearest lotr�ineff---- ------ <br /> DistanceDisposal Field: Distant P Barest well- -_-. <br /> Number of lines:{( 'SV. - -------Length of each line--__- __ fl_ -- Width of trench- --_.."___"-.._-°"___.-- <br /> 4 /d <br /> Type of filter ma erial" --�!� `Depth of fi4ter material_r_"I_- ,-__------Total length--- — -----_g------------------------- <br /> of <br /> ----------------`---- <br /> ° _• r <br /> Seepage Pit: Distance to nearest wel,LfaO__--.-.---Distance f om :f nd"ation" <br /> ----__-.Distance to nearest lot line-�r�_._--.." <br /> of pifs- -------Lining material--- <br /> - - --Size: Diameter �� -�`---Depth-..� -------------------- <br /> Number, t __ <br /> Cesspool: Distance from nearest well--__------------Distance from foundation--------------------Lining material_.-."---- gals. <br /> i <br /> ❑ -Liquid Capacity----------------------------9 <br /> Size: Diameter--- --------------------------- --.Depth------ , <br /> Privy: Distance from nearest well----"---------------------------- ------` Distance from nearest building_.".----__ <br /> ❑ st lot line--_-..._"---------------------------------- -------- <br /> ---------- -------------------------------- ----------- <br /> Distance to nearest <br /> . . - <br /> --- ------------------------- <br /> r � <br /> Remodeling and/or repairing (descr'be :-"--- - -_ �� <br /> --------------------------------------------------- <br /> I --------=----- <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. les and regulations of the San Joaquin Local Health District. <br /> ]s-.� L(-- -(Owner and/or Contractor' <br /> (Sii ]S 4� <br /> gned) -------- --------- I rr <br /> --- <br /> By: <br /> L� `----- - ---- -- (Title} ° <br /> [Plot plan, showing s' of lot, location of system in relation to wells, buildings, etc., can be place n reverse side}. <br /> FOR DEPARTMENT USE ONLY <br /> ' Gam= --- DATE------- 1 ��' :---------- <br /> APPLICATION ACCEPTED BY--------- <br /> BY----- -------------------------------- -------------------- ------------------------------------------------ DATE-- <br /> BUILDING PERMIT ISSUED------------------------- - t DATE <br /> -------- t - �^ - <br /> Alterations and/or recommendations:.-__--I--- -� 3 <br /> L I <br /> -------------------- ---- ---------- <br /> ------------ <br /> 4 ------------------- <br /> -------------------- <br /> - ------------------ ----- --I---------- <br /> FINAL INSPECTION BY:-------- <br /> Date................�fl --�-- ----- ---------------- <br /> ------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.kaxeltan Ave. 300 west Oak Street 124 Sycamore Street 205 West 9th Street <br /> ' Stockton,California <br /> Lodi,California Manteca,California Tracy,California <br />