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FOR ONCE USE: <br /> 3 _ X11 PXAA6. <br /> f 0Ar --------------------------�_3 o_. APPLICATION FOR� SANITATION PERMIT Permit No. -- - <br /> Jam.: - <br /> ------ ---------------------------------- (Complete in Duplicate) <br /> t � <br /> This Permit Expires 1 Year From Date Issued Date issued <br /> - s <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 application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION. -) } <br /> Owner's Name----- 11--el--------•- Phone-----• -------------- <br /> -... ---- <br /> ---- <br /> ' Z ." � s-------------- ----- -- <br /> Contractor's Namea ---- ------------------------------------------ --------------•-- ------ Phone---------------------------------- <br /> Installation will serve: Residence 0�"A`partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __l__ Number of bedrooms __'2-_-,Number of baths____ Lot size ----6-0-,.a(-----_� --------------------- <br /> Water Supply: Public system 1KIE-ommunity system ❑ Private ❑ Depth to Water Table ........ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [] Clay ❑ Adobek]k4Tc_-irdpan ❑ <br /> Previous Application Made: (If yes,date............--------) No I New Construction: Yes J?- No ❑ FHA/VA: Yes ❑ Nom <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> -(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic T k: Distance from nearest well----- Distance from foundation__/P_/-------Material___. �'.,�-/Z_�- -��____..___. <br /> No. of compartments------- ?rr.._______._.Size___ - ------Liquid depth------ Ca acit ___ <br /> / �?r p Y -------------- <br /> Disposa field: Distance from neares# well:__.^__ Distanceromoundation____(_'!...Distance to nearest lot line___..._____ <br /> ... <br /> Number of lines----------------------------------- of each line-------_cf'..C�_1._.E_.__.Width of trench._Q_�,--/_________________ <br /> Type of filter material----�_fj���_----------Depth of filter material--j-s-,-� g <br /> � Total length (-•-/--------- -------- <br /> 5eepag it: Distance to nearest well_._ '_`________Distanc m fo ndation___..._�_. .___.Dista`�e to nearesta lin _ l_._____ <br /> Number of pits------ ____ --------Lin g material_ __-Size: Diameter___ ._. _..__.._._.Depth____...__ .___.___ _ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation._..___.___ <br /> I <br /> p ------.Lining material------------------------------------- <br /> Size: Diameter--- ----------------------------------Depth-------------------- ----'-__-Liquid Capacity- ---gals. <br />` Privy: Distance from nearest wellr- ----------------------------------------------Distance from nearest building------------------------------ ----.-----. <br /> ❑ Distance to nearest lot line --------------------------- - ----` `------ -------------------------------------------------------------------------- ' <br /> Remodeling and/or repairing (describe):---------- ,----S,.e13 -V�---------S-- -------------------•-------------------------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------- --------------- <br /> :t <br /> ,1 <br /> I hereby certify that I have prepared this application.1nA fhafA-work will`b-e-done"in accordance with San Joaquin Count i <br /> ordinances, aws, and rules I eg lations of the San Joaquin Local Health District. <br /> Owner and/or Contractor .. <br /> (Signed)----- . ------ - ---- --------------i--------:-------------- ------- ( ) <br /> -------- <br /> By: ----- ----- --------- <br /> --=--'-- ----------------- le W._}, -— ---- ...-------------------- <br /> on <br /> --- ---- --------- <br /> Y (Ti( ) <br /> (Plot plan, showing size of I t, to ation of system in relation to wwee , uildings, etc., can be placed on reverse side). <br /> FOR DEPA51MENT USE ONLY r <br /> APPLICATION ACCEPTED BY -----__�_.l�__.-�,�------ ------ ------- I - 5 ---- <br /> - ---- ------- <br /> ------------------------------------- <br /> --------- DATE.---__- ---- <br /> REVIEWEDBY------------------------------------------------------ ---- ------------------7------------------------------- DATE----------------------------------------------------------- <br /> i BUILDING PERMIT ISSUED-------------------------------------- -- DATE------------------------------------------------------------ <br /> T__.fi - <br /> Alterations and/or recommendations: .- _ - <br /> h <br /> I ------------- - - -- --- ---- -------- ----- -------------------------------------------------------------------------------------- -----•---•------------------- <br /> I <br /> FINAL INSPECTION BY . ` ----- - ---------- Date --- ------- -- - <br /> i; <br /> SAN J UIN LOCAL HEALTH DISTRICT - <br /> 1601 E.Haielfon Avo. ' 300 West Oak Street 124 Sycamore„Street 205 West 9th street <br /> y <br /> Stockton,California Lodi,California. Manteca,California Tracy,California <br /> F.P.co. <br />