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FOR OFFICE USE: <br /> ........................._.. ----._-. __ ------------- APPLICATION FOR SAINITATION PERMIT Permit No. •r`� <br /> ---------------------------­ - --------- (Complefe•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 constru i and install thew k herein described. <br /> This application is made in compliance <br /> with County Ordinance No. 549. �,A �� <br /> JOB ADDRESS AND LOCATIONAx----�rl�" �,2p�,�r,� L`'� � � A <br /> t Phone-----•---- ----- <br /> Owner s Named -Y�- <br /> Address--.-_--- ------------ �' <br /> Contractor's Name Wa4 <br /> 1 s Phone. LI.--T�'. <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -( --- Number of bedrooms 9"'_ Number of baths -------- Lot size --- -_Q--' .._. - -. -__,•_---.-- <br /> Water Supply: Public system E] Community system [I Private [Depth to er Table ------ - ft <br /> Character of soil to a depth of 3 feet- Sand E] Gravel E] Sandy Loam lay Loam [❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,dote-------- ----...... ) No ❑ New Construction: Yes ❑ No 9—.FHA/VA! Yes-❑ --No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: `.- <br /> (No septic tank or cesspool permitted if public sewerDistance "or within 200 feet.) » <br /> Sep i Tank: Distance from nearest welf .------- =fo ateon-___� - Materi»I .-'-- - --------------------------------- <br /> No.-of compartments-,VN ....Sa - Liquid de th.... <br /> Di spo al Field: Distance from nearest well- .d� ..Distance from foundati9noLc ...�-.Distance to nearest lot line-.--- --.� O. <br /> Number of lines Length of each line-- __ ---0_�..._-__---Width of trench._!----------- -- <br /> Type of filter material. Depth of filter material-___,�. -- --� Total length--.-..-.----__--j --B-.�--.- <br /> Seepage Pit: Distance to nearest well-------------.- ----Distance from foundation------------------- Distance to nearest lot line---- -----. <br /> ❑ Number of pets... ........... . ..Lining material--------.--.---------- Size: Diameter-----------------------Depth--------------------------------• <br /> Cesspool: Distance from nearest well .. ------.......Distance from foundation_________________ __Lining material-.__----.__----__--.-.-----_-.--- <br /> ❑ Size: Diameter- -- -------- - --- ----------------Depth--------- - --- -- ---------- ----------------------Liquid Capacity---------------------------gals. <br /> Privy: Distance from nearest All________________________ ----------------------Distance from nearest building..-.___--------..----------------___._. <br /> ❑ Distance to nearest lot line.- - --- ---------------------- <br /> Remodeling <br /> -------------------Remodeling and/or repairing (describe)------- -----------------------------------------------------------•------------------------ ------------------------------------------------------------ <br /> --------------------------------------------------------- --- ---------------------- ----------------------------- 14- <br /> --------------------------------- ---------------------t --.----------.-----------.--------_-_-----------------..--------------•-•-_--_-------------__---•----_.---------.-.---_--------_-------.------------------------- <br /> ,`':'---------------------------------------------------------------------"-------------------------------.--------------- --------------------------------------.-------------------------------.------------------..._.__.. <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, Sta la , and rules and regulation of the Joaquin Local He Ith District. <br /> (Signed)--_ - -.. - <br /> - ---- -- ---' -- - -' -' - -- -'-'-' ---'-' '- ---'�'�• --'--- -- -- --- -'---- Contractor <br /> By--------------------- -------------------- ------------------------- -------- -- - - (Title)----------------- - --.-....-..--------- - ------ -------- <br /> (Plot plan, showing size of lot, location of system in relation to ells, buildings, tc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> 'APPLICATION ACCEPTED BY Yom_-_-------_- ------------------- ------------------- DATE_ J-9------------------ -------------------- <br /> 'REVIEWED BY----- -------------------------------------- --- - -----------------------------------'------------ ------------------------- DATE- <br /> BUILDING PERMIT ISSUED-------- ----- ----------- ----- --------------------- ------------ -------------------------------- DATE----------------- <br /> Alterations and/or recommendations-----------------------'--- -- - ----------------------------------------------------------------- <br /> -------------- -------------------------- ' --------------------------- ------- -------- ------------------------------------- --------------------'------------- ----------------- -----------------•------------------- <br /> ------------- --------------------------------------- -' ------------------------' ';':------ - ----------------------------------- -- --- ------------ -------- - ----------- -------- ------- ---------- <br /> ------ ----- ------------------------ '-' ' ...--- -- ---------- ----------- - -----------------•------------------- -------------------------------------------- --------- ------------------------- -------- <br /> FINAL INSPECTION ----•---------------- Date.----- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> Q� 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> )U Slocklon,California Lodi California Manteca,California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br />