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FOR QFFICE USE: <br /> -------------------:---------------- ----------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> -------------------------------------------•--- --•------ (Complete in Duplicate) Date <br /> Issued --------- ------ <br /> -------------------- ------------ -------------------- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct endinstallthe work.herein described. <br /> This application is made in compliance with County �ringa leo..5 <br /> P—. <br /> JOB ADDRESS AND LOCATION_... --------------------- ---------- /-�ARQ_L-- ------------- ------------�`___F -Lo-f-11j , <br /> ---- - <br /> Owner's Name-------------- ------ra <br /> P-4-f--------------- -- --�HMFISO_N--- -------- --------- --------- Phone----••---- -------------- ---------- <br /> -Addr - /------- ---A - 5r <br /> ess -------------------------------------------------------------- ------- <br /> Contractor's Name------PWMU�--------------------I------------------------------------------------- ----------- ------ Phone-------------------_ ------------ <br /> Installation will serve: Residence [Apartment House El Commercial [-] Trailer Court Ej Motel E] Other El <br /> Number of living units: ---I-__ Number of bedrooms a--- Number of baths! of size Z100---X----` -_-._____--____--_ <br /> Water Supply: Public system E] Community system E] Private kr Depth to Water Table �57—ft. <br /> Character of soil to a depth of.❑ <br /> 3 feet: Sand [] Gravel E] Sandy Loam El Clay LoamClay N El Adobe 0 ' Hardpan <br /> Previous Application Made: (If yes,date--------_1------- ) No �New Construction: Yes �o E] FHA/VA: Yes [ No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> ..--!(No s—c-pfic-fifriV*-oF-Z7e?ipo-ol-permitfed-if--Public-sewer;is available within--200-feet.) <br /> Septic Tek: Distance from nearest well-_5 ......Dista c 1from foundation-_._/�P--------Material__!��N <br /> ,;;2 X57___ 4/ Ca pacity___1_2_P<2___ <br /> No. of compartments-----. __Sj..___nY 2Q _Liquid depth___ �J. <br /> Disposal Field: Distance from nearest well___,5__0------Distance from foundation----AQ----------Distance to nearest lot line_,-�. -------- C)q <br /> Number of lines---------/----------r------------Length of each line.-.--- -----------Widtk of french-------:2- V <br /> r------------- - <br /> Type of filter material.....A04J.+____Depth of filter material----.-1. Total length---.----------- ---------------- - <br /> Seepage Pit: Distance to nearest well--M&--------Distance from foundation----149_------Distance to nearest lot line___, 7': <br /> ----------- <br /> Number of pits.....2-- ----------Lining mate6a1_RP<jK---- Size: Diarneter_�A.Ae?------Depth-------41?----------------­.- (M <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------.----.Lining material--_---._----__-- ----------------- <br /> ❑ Size: Diamefer--------------------------------------Depth-------------------------------------------------...Liquid Capacity- -----L�-------------------gals. <br /> Privy; Distance from nearest well----- - ----- ----------------------------------Distance from nearest building------..---_---------_-----------.-_. <br /> ro i <br /> ❑ Distance <br /> uilding---------------------------------------Distance to nearest lot line--------- ..........:----- -- ...... ---------------------------------- ---------------------------------------=------- ------------------ <br /> 0. <br /> Remodeling and/or repairing (describe):-------------------------- ------------------------------------------------------------------------------------------------------------------------------ <br /> ------------------------------------------------------------------------------------------------—------------------------------------------------7---------------------- ------------------------------- <br /> ----------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------- --------------------------------------------------------------------------------------------I----------------------------------------------------------------------------- ------------- <br /> I here4.,certify that I have prepared this application and that the work will'be done in accordance rdance with San Joaquin County <br /> ordinances, St to and rules gnd regul * ns of fhe'San Joaquin Local Health District. <br /> (Signed)-,,j- L---- ---------------- ---------------------------- - -------------- ------------------ -----------------------------------(Owner and/or Contractor) <br /> By ---------------------------------------------------------------I-------------- -------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE Ot4LY <br /> APPLICATION ACCEPTED 13Y--------7_,R__0---...........................•.-----__-_-- <br /> ---------------------------- DATE-------- ------------------- <br /> REVIEWEDBY---- ------------------------------------------------------------------------------------­­-------------------- --------- DATE---------------------------------------------------- <br /> BUILDINGPERMIT ISSUED-------------- --------------------------------------- ----------------------------------------------- DATE------------------------- ---------- -------- -------------- <br /> Alterations and/or recommendations---------------------------- ------------------ ------ -----------------------------------------------------------------r-------------------------------------- <br /> --------------- ------------------- ------------------------------- - - --------------------------------------------------------------- --------------------------------------------------­---------------- - <br /> ------- <br /> ------------------------------------------------------------------------------------------------------ -------------------------------------------------------------------------r-------------------------------------------- <br /> ------- --- --------- <br /> 7--------- ------------------------------- ----------- ----------=---- ------ - --------------------------------------------------------------------------------------- <br /> �/I........... / V ---------------------------------- - - -------------- ------------- <br /> --------------------------------------------------- .. ..... . ....... . ---- --- ------------------------------------------ <br /> --- -- ------- <br /> r4ld"0 UDate.............. ---------------------------------- <br /> _ -------------- ------ <br /> FINAL INSPECYIQ.tJ— <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 lVest Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California ManteWr California Tracy,California <br /> F.P.CD. <br />