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FOR OFFICE USE: �, y <br /> ----------------------------------"-----y------'-------- <br /> ---------------- <br /> -- <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> _ - 11 <br /> (Complete in Duplicate) I <br /> °fM� .-.-.--- This Permit Expires 1 Year From Date Issued Date Issued _ _�-5-_ <br /> Application is hereby, made:to, the San Joaquin Local Health District fo I <br /> pp . r a per it to construct and install the work herein described. <br /> This application is-mad/0)��AIT <br /> " mpliance with County Ordinance No. 544. � OF EPO _r <br /> '�kJOB ADDRESS AND I 00 <br /> --- ---- - -------- ---- -- --- - -----P;?........ - --- - ---------J49 --------- ------------------------------- ----------------:----- <br />.ttY ._ 3 <br /> .. . Owner's Name _ --- Phone----•• - <br /> io AIDPRZ5S to 7�oei=aril <br /> AddressA4- ----------- <br /> ------------------------------ --------------------- <br /> 2; Contractor's Name - ------- --------- Phone.. I <br /> Installation will serve: Residence �Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of livingunits: ______-_ Number of bedrooms _ of size ____-_ -_ ? <br /> ___ Number of baths --�t _ <br /> Water Supply: 'PUblic-system-❑-'-Community system'❑ Private [[Depth to Water Table 15J, ' <br /> r., <br /> Character of soil to a'depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam d Clay Loam ❑ Clay ❑ Adobe ❑ Hard n°❑ <br /> ,msµ' '; , <br /> "g -Previous Application Made: (if yes,date.................. .) No El" New Construction: Yes lE No E] FHA/VA: Yes Noll❑ <br /> "TYPE OF 'INSTALLATION.AND SPECIFICATIONS: — <br /> ­(No <br /> PECIFICATIONS: y,,.'(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> ay '`` Septic:Tank: Distance from nearest well__- _f__Distanye �om foundation--- ----------Material <br /> No. of compartments_7. <br /> •� - Size- --� depth------��.- <br /> 'paci#Y- <br /> i <br /> 4 �-(a-�u-�` quid . _Ca -- <br /> p s, <br /> Number of {ines________ _____ ___.- _ -Length th of each line_/Z__,zW�-rWidthcofttrench,est lo�ine__ <br /> Disposal field: Distance from nearest well_ � ___ - Distance from foundation___ _ <br /> Type of filter material__--A.-,Iof filter material length_____-_-___/�iZrf_________:':___.- <br /> g � I <br /> * -a F <br /> ;Seepage Pit: Distance io nearest well----------------------Distance from foundation_..................pistance.to nearest lot line----................ <br /> . Number of pits______________________Lining material_____ "�_ -_-Sizer Dia met sr------------ ._. iDep ------------------------- <br /> F __ <br /> Cesspool: lJistance from nearest well-----------------Distance from foundation. ___." Lining material_ __ l <br /> r <br /> v - - ------------- 1 <br />. `? Size: Diameter--------- Dept -----_- - 'Li uid Ca acit <br /> rt als. <br /> ----------- -- 9i <br /> Y` P.nvy: Distance from nearest well-------------------------- ---------------------Disfance from newest building___ <br /> �Fkr P q p <br /> ----------------------------- <br /> Y-- -- <br /> -� <br /> 3 ❑ ' Distance to nearest lot line------- -- -------- ---------------------------------- <br /> Q <br /> - ------ ---------------- <br /> s <br /> t <br /> Remodeling and/or repairing (describe)--------------- -------------------------------- ` � --- ---- - ----------------------- <br /> 4 Y1 <br /> f <br /> -------------------------------------------------------------------------------------------------------------------------_---------------------------------`----- ---- _ ' <br /> - a and that.the work will be done in accordance with San Joaquin <br /> hereby certify that I have prepared this application, County <br /> ordinances, State laws, and rules rid regulations of the'S'ari Joaquin Lacal`Healfli District. .fr j <br /> (Signed)------------- --------------------------------------------- <br /> (Owner and/or Centracfior� <br /> :,_BY•-�—=- � ,��_�,� �� - -- ------------------------------------------------(Title)-- .,_ ---- � <br /> k <br /> (Plot plan-,,showing_size of lot,._location of system in relation to wells@, buildings, etc., can be placed on reverse side}. <br /> LS <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------- --- ---I , R a-------------------- ---------------------------------------- DATE------ <br /> REVIEWED BY----------------------------------------- ------ DATE--.-- ----------- I <br /> BUILDING PERMIT ISSUED------------- -----------------------------------------------*---------------------------------------- <br /> DATE------------------------------------------------- ------ <br /> Alterations and/or recommendations------- - - ---------- --- -- <br /> _ . <br /> _. - ----------------- ---------------------------------------------------- . --------------------- <br /> --------------------------------------- _ <br /> ___ _____________________________________ ____________________________________________ ______________________________________________________________________A <br /> _______________________________________________________-. d <br /> 3 <br /> _____________________________________________________________ ____ _ <br /> _____________________________________________ ----------------------------------------; <br /> FINAL INSPECTIO ' Date-------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT .. <br /> 1801 E.Na:elton Ave. 300 West Oak Street 124 Sycamore Street <br /> Y 205 West 9th Street <br /> ` Stockton,California Lodi,California Manteca,California Tracy,California <br />