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------------ --------------------- ---------- <br /> '_ICATION FOR SANITATION PER Permit No. .�i <br /> ------------------------------------------ ......... (Complete in Duplicate) Date Issued1....-..-._-_ <br /> _...__.------ .._. ------------------:-------- --- This Permit Expires 1 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 application is made in compliance with County Ordinanv No. 549. <br /> JOB ADDRESS AND LOCATION- _ ® _ -----__ -_-_ <br /> � j ------------------------------- <br /> Owner's Name._- / j.. <br /> ------�.11_�_:.�-------- !4,. ��-- ---• ---•-- --------------------------------------- Pone-----•-------------------•---------- <br /> Address--------- :4? 0,yl.`4�' - <br /> _ ----------------------------------------------------------------- ------------ ----- --- --------- <br /> Contractor's Name------- �• a -/a-. �-�f--•-- _---------- ----------------------------------------------- Phone............................... <br /> Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: Z--. Number of bedrooms,.. Number of baths .e2- .._ Lot size Adeno- --------------------------- <br /> Water Supply: Public system ❑ Community system ❑ Private �epth to Water Table j�rft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay 8 dobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date_.................. ) No P-­"New Construction: Yes �lo ❑ FHA/VA: Yes R;_= No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well ti`�d~_ Distance from foundation_./e.........Mat?iall,,0�3K&oee_j�;..7!............... <br /> ®'" No. of compartments..'_- Size ..:"- Liquid depth Ca aci1-� <br /> Disposal Field: Distance from nearest well-- ..V.....Distance from foundation_.-,f".e._.._.-.Distance to nearest lot line__u:P r_�._..... � <br /> Number of lines.... ._.-._ ength of each line�iI_-__-- Width of trench.�.`.......................... <br /> ,�, <br /> Type of filter material � _ De th of filter material.__/�.. loo <br /> P --Total length...rg.��----- ------------------ <br /> Seepage Pit: Distance to nearest well......................Distance from foundation--------------------Distance to nearest lot line........- <br /> ❑ Number of pits--._--_--___-_----_Lining material...................... Size: Diameter-----------------------Depth------------------------ <br /> Cesspool: Distance from nearest well ................Distance from foundation...................Lining material........----------------- <br /> ----------- <br /> . <br /> ❑ Size: Diameter- -- ------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well.................................._..----._....--Distance from nearest building <br /> ❑ Distance to nearest lot line--------------------------------------- <br /> � �'�._ ... - - <br /> Remodeling and/or repairing (describe):._... 7 -- <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, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Si ned ,J �- <br /> 9 )----------------- jj � -_------------ ------- (�/-or Contractor) <br /> By:---- �L - � ` <br /> ---------•------------• ---- - - <br /> (Plot plan, showing size of lot, loc n of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-__......_ <br /> -----•-- -------G.E -------- ---------------------------------- DATE------�--��---=�--� ------,��.--� <br /> REVIEWEDBY----- ---------------- --------------------•---------------- DATE <br /> BUILDING PERMIT ISSUED-------------------------------------------------------------—-------------------------------------- DATE <br /> ---------------------------- <br /> Alterations and/or recommendations:----------_---------- -- ---- ----•--------- ._.. ----•----- <br /> .-• ---------------•-------------------------..-....-------------------------------------------------------------------------------............................----------------- --- <br /> ---------------------- --------------- •----•----•---------------------_-------------------------------------------------------------------- ------ •--- .................•-----•--- <br /> ----------------------------------------------------- ------------------------------•--------------------------------------------.._..----------------------•-•--••---•••-----•--- <br /> FINAL INSPECTION BY:.....GO_ --- <br /> -------- <br /> ------------ <br /> --- ---�/ Date----------•----- •--•-�s�=.....d...4�....... - ------- <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 /> E.H.92M 1-67 Vanguard Press <br />