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FOR OFFICE USE: ' <br /> I-- <br /> ----------- <br /> ----------- --------------------30 <br /> eAPPLICATION FOR SANITATION PERMIT Permit No. <br /> ­ <br /> ----- ------------------------------------------ <br /> ----------- -------------------------------------------=- (Complete in Duplicate) <br /> ._ This Permit Expires I Year From Date Issued Date Issued .3 91.1 <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descrbed. <br /> ,This application is made in compliance with County Ordinance No. 549. \ i <br /> JOB ADDRESS AND LOCATIGN------------------------------------------------------------ --------------- A�. -------------------------------- <br /> Is <br /> --- ----------------------- <br /> d 1 f <br /> Owner's Name prY -`� D_+sr.T -1-------------------------------- --------------------------------- hone <br /> Address--_----------------------- -----Ftt_d+,e,_U <br /> ..-e------�k_ --------------------------•----•-••------------------------------------------------------------------- <br /> - ---•------. Phone------------------------•---------- <br /> Contractor's Name--------- --- -- - ---- ..---------------------- -- -- ----------------•------------- ------ <br /> Installation will serve: Residence Apartment House ❑ Commercial [j Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _ember of bedrooms _Number of baths ----[_ Lot size ----X _3d---0----------------------- <br /> Water Supply: Public system R--r-ommunity system [1 Private ❑ Depth to Water Table -4/3S. ` -ti _ . <br /> Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam [-IClay [I Adobe Adobe ardpan ❑ <br /> Previous Application Made: iff yes,date--------- - ----} No Go o"New Construction: Yes jjg?�o ❑ FHA/VA: Yes ❑ No A— i <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) x�.( <br /> Septic Tank: Distance from nearest well------ Distance from�foundation_/Q <br /> ----------_Mater ial_,_.._ <br /> -- <br /> _______. <br /> 9--__ No. of compartments---------'L �------Size-3 ------Liquid deP, -Ca pacify---- - ----- <br /> Disposal Field: Distance from nearest we€l___ ^_--Distance from foundation__..-A 10 _._.Distance to n"arest lot line_xt...... <br /> [ Number of lines___._____-♦___ ____________________Length of each line_______` __0..l_____ ---.Width of trench__p�_ _��__..__.._----_._ <br /> J 1 i ._ Total len �� <br /> Type of filter material- !/? of filter material____ ._ length_ _�J___________________________ <br /> Seepage Pi : Distance to nearest welL____:`��4_.___Distance from�foundation---/_0:..1.--'Distance to n�arest lot li e-.�-------- b <br /> Number of pits--------,------------Lining material--------11.,bC,.k_.Size: Diamete __ x_�/__..._.Ditn_J�i <br /> Cesspool: Distance from nearest well-----------------Distance from foundation______________i----.Lining materidl-...______--------_._____________.I <br /> Size: Diameter------------------ -- ----De th------------------:------ ----------....Liquid Capacity_ gals. <br /> Privy: Distance from nearest well-----------_-----------------------------------__Distance from l earest�building_-,__._._____.___. a <br /> ❑ Distance to nearest lot line-------------------------- ---------------------------------{---------------------------, -------- �r <br /> --------------- <br /> Remodelingand/or repairing describe :__..____-_____._ �._1 _ _ <br /> ----------------•-•---------------------------------------------------------------------------------------------•- `----------------------------------------------------------------- ------- ------------------------ <br /> I hereby certify that I-Kae "p`repar"recc his app i`catio—na-d-`14 t the work will be done in accordance with San Joaquin County <br /> ordinances, State law Aq <br /> rules andngulations of the San Joaquin Local Health District. <br /> (Signed)----------------------- (� - -- ---------- - - - ------------------- . -- - ;------------- ------- .(Owner and/or Contractor) <br /> Y:---------------- --•---- } itle ( ;J�°-..r <br /> (Plot plan, showing size of lot, loc I n of system in relation to wells, buildings, etc., can , e placed on reverse side). <br /> Y. <br /> -* FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED B ------- ------ <br /> - ---------------------------�----------------�DATE--------------------��-- --------------------------------- <br /> REVIEWED <br /> ----------S ---------------- <br /> REVIEWEDBY------------------ - ----------------------------------- DATE--------------- -------------------------------------------- <br /> BUILDiNG PERMIT ISSUED - d- , DATE <br /> --- ------- <br /> -- -------- - <br /> Alterations and/or recommendations:__. <br /> -------------- ----- -------------- G------------------------ -------- - ---------------------------------------------------------------------`---------- ------- ----- ---------------------------- <br /> --- _=.. --------------------------------------------- <br /> ----------------------------------------- ------------- ------ ----------------------------------------------------------------------- ------------------------ ------------------------------------------- <br /> --••------- --- --------------------------------------- ��/ <br /> -------- <br /> FINAL INSPECTION BY - --- ------- Date---------- .--------- <br /> JOA LOCAL HEALTH DISTRICT <br /> 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.Cfl <br /> 1 <br />