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FOR OFFICE USE; <br /> ---------------- - ----------------- ---------- -------- <br /> --------------- -------------- .............. APPLICATION FOR SANITATION -PERMIT Permit No. <br /> ---------I ----------- ---- ---------- (Complete-in Duplicate) <br /> ----------------- ­------------- __­------------ This Permit Expires I Year From. Date Iss'ued 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 Ordinance No. 549, <br /> JOB ADDRESS AND LOCATIONIe <br /> --------------------------------------------------------------- <br /> Owner's Name-11-:1�_ -------- <br /> — Ph <br /> ------- -- --------------------------- <br /> ------- ------- -------- one <br /> Address-----------�/ �?_S_;2_0 <br /> Contractor's Name ----------- -- - ---- --- -------- -- -- <br /> ----------- !�r - ------------- <br /> ------ ----- ---------- ----- -- <br /> --------------------------- Phone------ <br /> Installation will serve: Residence Apartment House <br /> _] Commercial El Trailer Court 0 Motel E3 Other El <br /> Number of living units, Number of bedrooms �Number of baths.__L Lot size --------- ------------ <br /> ----- ------------------------------ - <br /> Water Supply-, Public system E] Community system E] Private E] Depth to Wafer Table ------ - ft I. <br /> Character of soil to a depth of 3 feet- Sand 0 Gravel [] Sandy Loam-E/Clay Loam E] Clay [:] Adobe[3 Hardpan <br /> ❑ <br /> Previous Application Made: (If yes,date__..-_ - -------- ) No El New Construction: Yes El No El FHA'/VA; Yes [7] No <br /> ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is-ay-aila ble within 200 feet.) <br /> Septic Tank: Distance from.nearest weli-----------------Distance from foundation__._-------..._____.Material ------- -- <br /> El No. of compartments---------- -----------Size----------- -------- ----------Liquid depth--------- ------- ----------- <br /> --------Capacity----------------------- <br /> Disp;o ,1,,Field: Distance from nearest well---- '40-------Distance f rorK founc1afion.__JP_1....:_...'Disfan6e'fo nearest lot line-4............ <br /> --.Width 6f tre <br /> Number of lines------------I-------------- 1�---Length of each ......... Lnch I-?_ <br /> Type of filter <br /> material----- ----------Depth of filter material _-Total le'cjt -4------- ------------------------- <br /> II - n h.... .A------------------------------ <br /> a qfiK I <br /> Seep Pit Distance to nearest welf-,.... Distahce fr&m founclatlon.,____/V-------- Distance to nearest lot line_S. �j <br /> Eff' Number ofpitsl-- ----- .__Lining material------ I <br /> Size: Diameter---%]?C�.......... <br /> I <br /> cesspool: D15tarce from�,nearest well ________________Distance from foundation__.._-____._...._ .Lining material_-.._______-__----____.____------_ <br /> ❑ Size: Mameter:I- - ------------ --- ...........Depth:-­�_....... <br /> -t ---------------- --------------------- Liquid Capacity----------------------------gals. <br /> Privy❑: Distance from 'nearest well <br /> I -------------- - -- ----------.-Distance from nearest building--------------------------------- ------- <br /> Distance to necrest lot line ----------- <br /> - <br /> ------------------------- - ----------------------------------------------- ---------- <br /> Remodeling and/or repairing (describe'): ---- <br /> �----I-------- ------------------------------------------------- <br /> .............. ---------- -------------- ----------- <br /> ----------------------------------------------------------------------- -------------------------------------------------------------- <br /> ---------------- <br /> ----------------------------------------------------------------------------------- <br /> ----------------:--------------------------------------------------------I-------------------------------------------------------------- <br /> - -------------:-------------------------------------:---------------------------------------------------------- -------------------------------------------------------------------------------------------------- <br /> I hereby,certify that I have prepared this application and that the work will be dome in accordance with San Joaquin County <br /> ordinances, State laws, and Iles and regulations of the San Joaquin Local Health District. <br /> (Signed)-------------------- <br /> - <br /> .------------------ . ... <br /> - --- ----- ------ -- ----- --- - -- ------------ -------------- -------------- - ---------------------------- - <br /> 7CZ2M!N�d/or Contractor) <br /> By:------------------ <br /> - ------- --- ---------- ----- -- -- -----------------.............--.--(Title)--------- <br /> -- - ----- ------------- .......... ......... <br /> (Plot plan, showing size of lot, locaf4;o:n of system in relation 0 Wells, buildings, etc.,' can be placed on reverse'side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_ ----------------------------------------- DATE Z/ <br /> REVIEWED BY...- -N. ------- ----------------- <br /> --- -1.......... <br /> ISSUED;r, -- - ------------ -------- --------- --- ------------------------------------------- DATE-------------------------- <br /> BUILDING PERMIT ---------------- ................. <br /> .; ------ - ------------------------------- DATE----- -- --------------- <br /> Alterations and/or recommendations:_ ...... ,", <br /> I ------ ---------------------------- <br /> ------------------- -I--------------------------------------------------------- ------ <br /> ------------------------ ---------- --------------------------- ------ --------- -- ----------­­-------------------------------- <br /> I ------------------------------------------L....................... <br /> ----------------------------------------------------------------I------------------------------- ------------------ ------------- ------------------ ---- --------- <br /> ---------------I---------------- ---- ---------- ............ I - --------- ---------- -- ------------------------------------­ <br /> II ...............--------- ------------- .......... -------------- ------------ ---------I—- ­............... ---------- <br /> ........... --- ------------- - - --------------- <br /> - ..... .......................... --------------- ------------ - ------- ------------------------- -------------------------------- <br /> FINAL INSPECTION By--- ---------------- <br /> ---- --- -- ------ .......... Datel -/ <br /> SAN JOAQ UIN LOCAL HEALTH"DISTRICT <br /> 7601 E.Waxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Slacklon,California Lodi. California Manteca,California <br /> E.H.9 2M 1-67 Vanguard Press Tracy,California <br />