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FOR OFFICE USE: <br /> --- ---------------------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> - --------------------------------------------------- 'Al (Complete in Duplicate) ( .. Date Issued -/------�)__13 <br /> ---------------­ �----------- --­__ This Permit Exeires I Year From Date Issued ; <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 applicp.1 ni is ma e in c with County Ordinance No. 549. <br /> c k),L-0 A, <br /> E <br /> JOB ADDRESS AND 'Tyl -m--------- ......Ear------M---vp,_p.- ------R,I3-------------------- <br /> Owner's <br /> /--- ----:------------------ <br /> Owner's Name--------------------13_i_L�--------- ------W-y- -,K--------------------------------L----------------------------------------- Phone------------------------------- <br /> Address-............... --_,BOX---------J-3-7-6—------------------------------------------------------------------------------------------------------------------------- <br /> Contractor's Name__UAWFKKq✓AID------U_P_L1_VE's------------------------------------------------------------------- Phone----------------------------------- <br /> Installation will serve: !Residence K��Apartment House [] Commercial E] Trailer Court El Motel El Other n <br /> Number of living units: -INumber of bedrooms 2-- Number of baths --- ---- Lot size ------&'REz__k�---------------------- <br /> Water Supply: Public system E] I Community system El Private P�Depfh to Wafer Table t. <br /> Character of soil to a depth of 3 feet: Sand (:] Gravel E] Sandy Loam E] Clay Loam 2-16ay E] Adobe E] Hardpan <br /> Previous Application Made: (if ye&ote _.----_-----------) No 2--_'New Construction: Yes E] No [n-___F_HA/VA.. Yes E] No E _ <br /> TYPE OF INSTALLATION AND <br /> .,SPEPPjFICATIO NS: <br /> (No septic tank or cesspool permitted if public sewer is available wthin 200 feet.) <br /> Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material------------------------------------------------ <br /> EXL[25-r)^fC7--- No. of compar;men'ts--------------------------Size--------------------------------Liquid depth------------- -- ---------Capacity----------------------- <br /> S <br /> Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line_________________ <br /> E:- <br /> ine----------------- <br /> E:-K]STJ tf& Number of lines----------------------------------Length of each line_------- ------------------.Width of french----------------------------------- <br /> Type of filter m'ateriaI_____.-------------------Depth of filter material-----------------------Total length_________________: <br /> Pit.- Distance to nearest well-__A00----------Distance from foundation--- to nearest I 1'rie-,$7------- <br /> C <br /> % -Number of pits'----/-------------Lining material-RO-CA Size: Diarneter3 2�-------.---Depth_-W-------------- ------ <br /> '! -4- <br /> Cesspool: Dstance from nearest well---"_____._-___Distance from foundation....................Lining material_------ ------------- ------------- <br /> ❑ Size Diameter.-[------------------------------------Depth----------_j:---------------------------------------Liquid Capacity--- ------------------------gals. <br /> Privy: Distance from nearest well_---_- --- -:---------------------------- <br /> ---------- ---------------------- ......Distance from nearest bu;�ding---------=---- --------------------------- <br /> ❑ Distance to nearest lot line.----------------------------------------------------------------------I--------------------------------------------------------------------- <br /> I i — <br /> Remodeling and/or repairing (describe):- ------ ------------------------ -------------------------------------------------------------- -------------------------------------------------------- <br /> rI------------------------------------------ -------------------------------------------------- - <br /> ------------------------------------------------------------I f <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, and rules avid ulattons of the San Joaquin Local Health District. <br /> (Signed)- -- -- ------ -- ---- ............ �el- ----- <br /> ff_r_� .-- __ - -- -- ----------------------------------------------------------------- -------(Owner and/or Contractor) <br /> Title <br /> B :- <br /> ---------------------------------------- —------------------------------------- ------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can 6e placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----- ---------- ---------------- - - -------------- DATE ---19. . <br /> ----------------------- <br /> REVIEWEDBY--------------------------------- ------- --- -------------------- ----------------------------------------------------------- DATE------------------------------------------------------------ (r, <br /> BUILDINGPERMIT ISSUED-------------- ---------------------------------------------------------------------------------------- DATE-------------------------------------------------•---------- <br /> Alterations and/or recommendations:._._______.__-.__.___._ --­--------------:------------------------------------------------------------I-------------------------- <br /> -------------------------------------------------------------------- ---------- ----------------------------------------------------­-------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------I------------------------------------------------ <br /> --------------------- ------------------ ---- I---------I----------- -------------- -- -----I---------:_�------------------------------------------ ------------------------------------------- <br /> -----------------------------------I—------------- --- -- ... ................. ---------- --------------------- ------ <br /> ---------------------------------------------------- ----------------------------- <br /> ------ - ---- --- Date-------- -- -------------------------- <br /> FINAL INSPECTION BY:-.-. ------- ....... -------- --- ------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E,Maxeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lod:i,California Manteca,California Tracy,California <br />