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FOR OFFICE USE: <br /> 4 yr r17 <br />------------------- - <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------ f (Complete in Duplicated Date Issued --- --- <br /> ------- This Permit Expires 1 Year from Date Issued <br /> I Health District for a permit to construct and install 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. <br /> il <br /> JOB ADDRESS AND LOCATION-..-_��-�-�'-�--------"--�--- ------- <br /> Owner's <br /> ---01 l__V _. -�S�'.-------- <br /> --------------�------- -•-------- ----"--- <br /> Owner's Name------��--yy- e -------auo-tf----- � . -------- --------------------- Phone---- <br /> --------------------------------------------------- <br /> -_9 <br /> --------------•------•j--"-"•-'----�---Q----I-_-----_- <br /> Address----------.".. - X------TE;-------------- ��;.rd_t-----al <br /> ------ ---- Phone""�L.�"hP-'4_�a Q-�.. <br /> - - ------------------------------------ <br /> Contractor's Name----p'A'._�,Q1rY"�5-- -�--SQ. "--------------- ------ - -- - <br /> Commercial Trailer Court ❑ Motel ❑ Other ❑ <br /> Installation will serve: Residence ❑ Apartment House ❑�, ❑ � o•"-" --"- ------ -- <br /> --- Number of baths----�-- Lot size ----- ---+2�..X__-7Q- <br /> Number of living units: _" --_." Number of bedrooms ..� i <br /> � j <br /> Water Supply: Public system k 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'% -' New Construction: Yes C1 No X FHA/VA: Yes ❑ No I <br /> 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 foundation--.---------.__"__.Material._--"....-.--__---__"."-"----"---"..- <br /> No. of compartments Size------------------ - ---------- Liquid depth--------- - -- -- - Capacity <br /> ❑ -- ---- <br /> Disposal Field: Distance from nearest well_..'__."" i Distance from foundation--"".-.--------.Distance to nearest lowny"""-------------- <br /> Number of lines------------------ ----•-------Length of each line................ �_ r -Width of trench----_:-_-- ---y._-------------- <br /> Type of-filter material.__5 ---------Depth of filter materEa!""- .�l __-.-.-Total length-- ------------____.______-_r_-.- <br /> t AdL f <br /> Seepage Pit: Distance to nearest well---l.h.�-1r.jW-Distance from foundation_"" .__-.".-.Distance to nearest lot line"-- �.-"..-" <br /> Number of pits...I---- ------------Lining material---------3- "---- Size: Diameter-----33.�t ---.-.Depth-----.------ <br /> 5- ---------- ° <br /> I <br /> Cesspool:; Distance from rie.arest well "---''-____:"_Distance from foundation:.._......_"____:..�i nundg material <br /> tgals. <br /> ❑ Size: Diameter- _ - - ----------------Depth--------- ------ ------------ ------------------- q <br /> tt :Distance from nearest buil&ri <br /> 4 Privy: Distance from nearest well---------- -------- --- -"-- ----- ---- -- -----------------------------;------- ----- <br /> ❑ ------ -- --- ------------- - ----- - A ' <br /> - Distance to nearest lot line -.-".__.--.-_:_.-_- - - - -describe) kKl"S 1- lj.YL�---- ?_I" `^"=✓j-Vl-O_ Yq" T <br /> Remodeling and/or repairing { t =-- -- ---- - (~ <br /> - a"hls O,�c e ---------------------------------- - --- ---- - ---------------- ---------------- <br /> t--------- ---------- ------------- <br /> p ---------------- <br /> - - - --•------------------------------------ ------------------------------------------------------•-------------------------- <br /> I hereby certify that I have repared 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 /> I <br /> ..(Owner and/or Contractor] <br /> s <br /> (Signed) <br /> - t---- -4----- 7C.5�l-$ ------ - <br /> f ---------- ------------(Title)- -------- --- �- <br /> (Plot plan, showing sixe of lo�loca, of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY___--. -- DATE--._- -- -_I 6--$---------------------------- <br /> DATE--------- - ---- - ----------------------------------------- <br /> REVIEWEDBY------------------------- --------- --------- --------------------------------------------- <br /> BUILDING PERMIT ISSUED-------- -_ ----------- ------ - DATE <br /> i --------------------- ---------- -------------------------------------------- <br /> Alterations and/or recommen ations:..._."..._.- <br /> --------- ----------------- -- --- - - <br /> -- - ----------- ---------- ------------ - --------- --------- <br /> C `� \------------------------ Date--- z ----- -� - <br /> FINAL INSPECTION BY:...__- - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 16o1 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California <br /> Lodi, California Mantecar California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br />