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ruK ul'f-K-t ubt: _ <br />..................................... ------ ---- <br />APPLICATION FOR SANITATION PERMIT Permit No. .1;L1,11e9czz.#- <br />-- ---------------_---------------- .............. (Complete in Duplicate) <br />I - -- This Permit Expires 1 Year From Date Issued Date Issued <br />Application is hereby made to the San Joaquin Local Health District for a permit to constrict and install the work herein described. <br />This application is made in compliance with County Ordinance No. 549. <br />JOB ADDRESS Ab LOCtON�%-..d-!'-iG.�..v. P0`10- 02— <br />Owner' <br />s <br />2— <br />Owner's Name(..o'`-'-`-'�'----------------- - - ----- - - --- -------....... ............. Phone...--------------------------------- <br />Address -------------� <br />Contractors Name - ....... ....�......................... Phone..------- ---------------••-• - <br />Installation will serve: Residence ❑1. Apartment House ❑ Commercial [Trailer Court a Motel ❑ Other ❑ <br />Number of living units:"' _ Number of bedrooms"' Number -baths ---- /.. Lot size -------------------­- ..... <br />Water Supply: Public system ❑ Community system [] Private Depth t ater Table .:..__._ ft. <br />Character of soil to a depth of 3 fee t: Sand [-]Gravel E] Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br />Previous Application Made: (If yes,dote....................) No j] New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank_ or cesspool.p;rmitted-if public'sewer is available within 200 feet.) <br />Septic Tank: Distance from nearest well ---------- Distance from foundation.. ..................... Material.._......._ ...................._..___-_....... + <br />ElNo. of compartments ............. ............. Size --------------------­ -• :: ` Liquid. depfh.. -----................. Capacity -•--------•------..._. <br />I or <br />D;spo Field: Distance from nearest well _.S ------ Distance from foundation.__.1d._____..^ Distance to nearest lot line,x............ <br />` Number of lines.1._._......... Length of each line___---..- ............Width of trencn...�`....._ <br />Type of filter material.-_-----. . ------Depth of filter material...../_�_`�.........Total length....._-c-� -_- ------------ •.......... <br />Seepage Pit: D'stance to nearest well .......... ............ Distance from -foundation ------------------- .Distance to nearest lot line .......... ....... <br />❑ Number of pits--- -- ----------- ::_. Lining material---------- ------------Size: Diameter_..__...--.... ------- Depth ...... ............................ <br />+ <br />Cesspool: Distance from nearest wail ------------ ...Distance from foundation__________ __ ___Lining material-._......._..--_................._.. <br />❑ Size: Diameter. --.1 --------------------- .... Depth-.--------- -­------------------- ----- Liquid Capacity .......... ... gals. <br />Privy: Distance from nearest well ............ .. ........ ......------------------- Distance from nearest building., O <br />171Distance to nearest lot line - :..... .---- I...... ---------- la <br />.......... <br />Remodeling and/or repairing (describe):.....-----------------------•----....---•----•--....---•...._----•-------------------- ' ------------------------.......... <br />--------------------................................... aP <br />I <br />...................... --------------------------------------- ••-••-•------•-••-•••...-----------------•-------•---------------------------•--.............................................. <br />1 <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 <br />( 5 ) .. _--------- ---------------------- -----•--....._....................... -- 9rwer and/or Contractor) <br />6 <br />By:----------------•---•---------------------- ............... ----_-------.----------- --- ---- •-----------------------(Title)_ ' <br />(Pio+ ppl' n showing size U -16—f, lii ati n of system in rela ion towells, b'uil�ing cf-, can- be la ed o e else side). <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY- - ---------- ------------------• - - DATE--a..'.'Z - ..._.......... <br />REVIEWED BY. _..... DATE - ------ <br />BUILDINGPERMIT ISSUED ........_............ ......----------------------------- . ...........................--------- DA -TE-... ----------------------------- <br />Alterations and/or recommendations:-,-----•--•------- ------- ------------------------.--- <br />---------------------------•-----•-... ............................................................. --------------------................................. ----•------------- • -•---------•••..........--.•-- <br />... --------------------------- ...--------------- 2 ............................... -----.......................... ....-•-•----•-•-----------...................................... .................... . <br />............. .......................................................... ------•---,------......... •-•----.......................................... ...... ------------------------------------------------------------ <br />r <br />FINAL INSPECTION By,.:...��' a�•"r_. .......... Date.._ - .... .......-------------- - ---------------- <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1601 1. Naxelton Ave. 300 West Oak Street 124 Sycamore Street <br />Stockton, California iocil, California <br />F. p. C o. <br />Manteca, California <br />205 West 9th Street <br />Tracy, California <br />