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FOR OFFICE USE: <br /> ------------------------------- --------------- <br /> -------------- ----- ----- --------------------------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> ..................... <br /> --------- ---------------------------------------------- (Complete in Duplicate) <br /> -------------- ----------------------------- ---- --- - This Permit Expires I Year From Date Issued Date Issued ---ir-P <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. <br /> JOB ADDRESS AND LOCATION------ Nk�q�q�� <br /> --- ---- <br /> -- ----- ----------- -- <br /> Owner's Name.--- (URW---- S'�C�------j ----------------------------- ------ -- ------------------------ Phone__VAi--QScV7------ <br /> Address................. ------------- <br /> ra <br /> Contractor's Name--- <br /> ---------------------------- <br /> --------------r----------------------------------------------------- Phone----_--------------..-... <br /> Installation will serve. Residence E] Apartment House E] Commercial FTrailer Court ] Motel FOther Bs6 I <br /> _k <br /> Number of living units: Number of bedrooms -------- Number of baths -------- Lot size -------------?_/------------------- --------------------- <br /> Water Supply: Public system. E] Community system [] Private []r-Depth to Water Table ft. <br /> Character of soil to a depth of 3 <br /> ifeet: Sand j Gravel ESandy Loam [ Clay Loam ❑0 C1ay ❑EAdobe ©Hardpan <br /> El <br /> Previous Application Made: I If yes,date-------------- ---.1 No E?"-New Construction: Yes E] No [� FHA/VA: Yes 0 No E' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> i <br /> Septic T nk: Distance from nearest welL.P-ay-koisfance from foundafion__Z� ---------Material.........e 0 AJ C qSA__._ <br /> ------------------------- <br /> No. of compartments------ -------- ----------Size------------ --------------------Liquid depth----------------------Capacity------------- ---- <br /> Disposal isp salField: Distance from nearest well.i;9570-j�Distance from foundation.-/C-0...........Distance to nearest lot line__ _0_f_- <br /> Number of lines--------_ R-------------------Lengt� of each line-------/67P line--- -- -------------Width of trench.----_R--f------------------ <br /> Type of filter material_'0'.p__R. .........Depth of filter material-----/?..__ ____._Total. length--------- --------------------- <br /> 14�00 1 <br /> Seepage Pit: Distance to nearest well- ------------------Distance from foundation------------- ---.-.Distance to nearest lot line__.___________. <br /> .E] Number of pits_------------------- Lining material--------------------_--Size: Diameter-----------------------Depth-------------------------------- <br /> Cesspook Distance from nearest well-----------------Distance from foundation-------------- -----Lining material___.._.._____.________-..__________-- <br /> .. Size: <br /> aterial-------------------------------------- <br /> Size: Diameter---- ------------- -- ----------------Depth------- -------- -----Liquid Capacity----------- ----------------gals. <br /> ------------------------- - --- <br /> _7 <br /> Privy: Distance from nearest well building------- <br /> ------ -------------------------- stance from nearest <br /> ❑ Distance to nearest lot 1ine---------------------- ----- ----------------------------------------- <br /> Remodeling and/or repairing (describe]:_.._-- pp,�'I(w----R-----fxks_zz_AA-------gy.k.T <br /> - -------------------------------I------------------------ <br /> -------------------------------------------------------------------------------------------------------------------------------t------ -1—1 . .1 <br /> ---------------------------------------------------------------------------- -- <br /> ---------------------------------------------------I-------------------------------------------------------------------------------- ---------f------------I------I------- ---------- -------------------------- <br /> --------------------------------- ---------------------------------------------------------------------------------------------------------I----------------------- --------------------------------- - -- - ----- <br /> I hereby certify that I have prepared this application and that the work will$ie done i_n`A­cco'r'dan'ce with San Joaquin County <br /> ordinances, State laws, and rulesandregulations of the San Joaquin Local Health District. ' I i <br /> (Signed]-------- --n-. --- ---- --------- <br /> ---(Owner and/or Contractor] <br /> -------------- <br /> By: -------------------------------------------------------------------------------------------- ---------- <br /> (Plot plan, s owing size of lot, location of system in relation to wells, 6uetc., can be placed on reverse side). <br /> FOR DEPARTME ISE ONLY <br /> APPLICATION ACCEPTED ------------------------------------------- DATE-----X-::R7o�,g <br /> _T_E.... .... 0 -- ---------------------------- - <br /> REVIEWED BY-------------- ..... ---- -- ------------- ------------------- DATE-----.- ---------- <br /> ------ ----- ---- <br /> BUILDING PERMIT ISSUED--------------------------------------- ___------- ---•---------------------------------------- DATE <br /> Alterations and/or recommendations------------------ ------------------------ ------------------------------------------------------------------------------------------------------------- <br /> ---------------I------- -------- - ---------------------------------------- -------------------------------------------------------- -------------------------------­­------------------------------­------------- <br /> ----------------_--------------------------------------------­_---------- -------- ---------------------------------------------------------•-------------------------------- ------------------------------------------- <br /> ---------- -------------------- ------------------------------------- ------------------ ------------- ---------------------- ----------------------------- ---------------------------------------------------------- <br /> ---------------------------------------- -- - - -- ---- - ------------- ------- - ------------------------------- ---- --------------------- <br /> ------- <br /> FINAL INSPECTION <br /> Date <br /> W. -------- ........... ............. <br /> AN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Nazellon.Avo. 300 West Oak Street !Q 4 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California <br /> Manteca,California Tracy,California <br /> F.P.Cu. <br />