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FOR OFFICE USE'' <br /> ----------------------- ----------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. .1 --F� __ <br /> (Complete in Duplicate} <br /> ----------------------------- -- - Date Issued <br /> -----------------------------------------------------____ This Permit Expires 1 Year From Date Issued 2_Yf--a4,0 2./, <br /> Application is hereby made to the San Joaquin Local Health District for a pe�r�m;i•tYto_const�uct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 544. W! f <br /> JOB ADDRESS AND LOCATION ¢-' t___.__ ---------------Sell /f�� `� <br /> r=.- ft '-`— !---------------- - <br /> ,,/ c - -- ---- .-.. <br /> Owner's Name------91 ,6.61; ---------�J C3_ ra, 'j'�1----- ------------------------------------- Phone_--•---•-••------------------------ <br /> Address----------- ------------------ ---------------------- <br /> Contractor's Name-------- -------- Phone_ (�-_31 " <br /> Installation will serve: Residence gq-`A_partment House ❑ Commercial ❑ Trailer Court ❑ Motel [❑ Other ❑ <br /> Number of living units: A- Number of bedrooms Number of baths -_{-._ Lot size ---- ___________------___:___._..---...__-________-__-_ { <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table-a 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-----------.-------.I No ❑ New Construction: Yes ❑ NoFHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ��ll. f ins <br /> ��,/Tank: Distance from nearest well_- '��_.-_Distance from foundation-/-O.p__._..Maferial__P6`"----------------- <br /> SepticW . <br /> L'S No. of compartments___._.-.-----__r.____Size�Y_�`,_1_�-----Liquid depth...-�_-...._---------Capacity_/�G_C._�� , <br /> Disposal Feld: Distance from nearest well.-5.Z3.........Distance from foundation--/-4 Distance to nearest lot line.�..------_. <br /> Number of lines___ ----__ Length of each line -..-.Width of trench------- ___________________ J <br /> Type of filter material-__-J�-__�Q4Depth of filter material____ ._.._..__Total length.____.___.__¢ ___�___r__ <br /> Seepage Pit: Distance to nearest well-------_--------------Distance from foundation--------------------Distance to nearest lot iine!_� .. <br /> ❑ Number of pits----------------------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 well----___------------------------------------------Distance from nearest building___.._:---_-_._.--_-_-__-__-------__.__. <br /> ❑ Distance to nearest lot line----------------------------- --- ---------- - ----------------------------------------------------------------------------------------- <br /> - r, <br /> Remodeling and/or repairing (describe):--------___-------Z� -------_✓.__ <br /> L <br /> J <br /> ----------------------------------------------------------•-----------------------------------------------•------------------------------------------------------------------------------------------------------------------ <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, St law , arld rul and egulations of til San Joaguin Local Health District. <br /> (Signed) ----- ------------------------ ----- ----- ---- -- Owner and/or Contractor <br /> By:----------------------------•------•--------•--•---- ----- --- ----------------{Title) <br /> (Plot plan, showing size of lot, location of system in relation to we s, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> T <br /> APPLICATIONACCEPTED BY------------------------------------ - ----------------- ---------------------------------------- DATE--------------- <br /> REVIEWEDBY------------------------- --------------------------------------------------------- --- -------------------------------------- DATE---------------- --------- <br /> BUILDINGPERMIT ISSUED---------------------------------- --------------------------------------------------------------- -- DATE.--- ----- - <br /> AI#erations and/or recommendations:____________________________ �------------------------------------- <br /> -------------- <br /> _________.__ - t'``r��- <br /> -------------- ---•------------------------------------- <br /> --------------------------- ------------------------------ ----------------------------------------------- ------------------------------ ---------------------- -- <br /> n----�•--��- . <br /> - ------------ -------------------------------------------------------------------- <br /> ---------------- <br /> --------------- --------------- --- -,- --------------------------------------------------- <br /> -----------------------I------------------------------------- <br /> ------------------------ -- -------------------------------------­--------------------- --------- <br /> rq <br /> � �� --------- <br /> --------------------------.1----- - I <br /> N--------------------------------------------------------- <br /> / <br /> ------------------------ - --- -- ----------- <br /> FINAL INSPECTION BY:- - Date-- ------------- �/ ------77- , --------------- <br /> l <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />