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J FOR OFFICE USE: <br /> ----- ------- <br /> Permit No, 342-7... <br /> APPLICATION FOR SANITATION PERMIT <br />-.--_-.-..-"."-.--..-"..".-"""."-""."..""....-. "r --- <br />----------------------------------------------------- --- (Complete in Duplicate) Date Issued <br /> ___!_ _____ /(o <br />---------------------------------------------------------- This Permit Expires I'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 complianc6 with County Ordinance No. 549. <br /> JOB ADDRESS AND L CATION -- ' <br /> 1W, a�� ------- ------ ---------------------------------- -------------------- ---------- <br /> ------ ------------------- <br /> Owner's Name ------------ -- ----------------------------------------- Phone-----"---------II----------------•--- <br /> f7_ <br /> hone--------------J-------------------- <br /> .... . ... . <br /> -- --------- ---------- -- ---- -- ----- - <br /> 01 <br /> C: VY <br /> Address- ------ 'moi------------ ------ -----------L-----------_-------- <br /> _�Z*--------------------------------------- ------------ ----------------------------------------------------------- .1 <br /> Contractor's Name------L ---- --- -------- ---------------------:--- ---------------- Phone-----------------1-_--------------- <br /> Installation will serve: Residence ❑ Apartment House E] Commercial E] Trailer Court E] Motel [3 Other <br /> Number of living units: Number of bedrooms -------- Number of baths Lot size --- 5C /,_5-0 <br /> - - ---------------------:�___ ____________________ <br /> Water Water Supply: Public system M--dommunity system E] Private F-1 Depth to Wafer Table _Wft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel [] Sandy Loam D Clay Loam [] Clay 0 Adobe [3' ;Hardpan 0 <br /> Previous Application Made: (If yes,date.___..__-.- - No R2 New Construction: Yes E] No.[R` FHA/VA. Yes .E:1 No El� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:' <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Se Distance from nearest well_________________Distance from foundation--------------------Material--------------- -----------�L-------------------- <br /> Septi <br /> ii <br /> No. of compartments--------------------------Size--------------------------------Uquid depth---------------------- Capacity--.,--- ------ --------- <br /> I <br /> ---------Distance from foundation ------------Distance to nearest lot lihe--,5---------- <br /> Disposal/F�iv. Distance from nearest we]__.._T. <br /> Number of lines___-___-__---_-___i ------------- --Length of each line_c2A_-J"-----------Width of trenchlr----- .................... <br /> Type of filter material- POCA---------Depth of filter material.--- ----------Total length------- -------------------- - <br /> Seepage Pit: Distance to neare9f —-----------Distance f <br /> —4om foundation---/A---------- Distance to nearest lot <br /> Number of pits_._-I-----------------Lining materiaI__rjj�PA_X....Size: Diarnefer__3__,r.............Depth___---- ------------ <br /> 0 <br /> Cesspool- Distance from nearest well-----------------:D,i-sfance from foundation--------------------Lining material.___.._-----____ --------------- <br /> El SiZE7. Diameter._'Al D' ---------------------- <br /> ----------------------- --Depth ----- -------------- ------.Liquid Capacity-.------------'------------gals. ri <br /> PrivDistance from nearest well------ --- ---------- ----- ------ -------------Distance from nearest building-----------------------im------------------- <br /> El <br /> Distance to neareit lot line.....................I <br /> Y' <br /> _911N I <br /> ---------- ------- ------------------------------ -----------•------------------- - ---------- <br /> Remodeling and/or repairing (descril):----------------------------------------- ---------------------•----- ----------------I--------------­­------------ -------------------- <br /> 3 <br /> it :I <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------- <br /> -----------I--------­­---------------r-----------------I------------------------------------------------------------------------------------------- ------------------------------------------------------------------- <br /> 1 .1 J <br /> ---------------------------------------------------------- ------------M---------------------------------------------------------------------------------------------------------- ---------- <br /> I hereby certify that I have pre�ared this application and that the work will be done in accordance with San Joa` uin County <br /> p q <br /> ordinances, State laws n rules and'regulations of the San Joaquin Local Health District. <br /> (Signed)-------------- ---rr -------------------7a- A ----------__----------------- ---------------(Owner and/or Contractor) <br /> R,__---------------- ---------------------------- ---------------------------------------(Title)------- ----------- ------ <br /> ------- ---- -------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> I FOR DEPARTMENT USE ONLY II <br /> 0007 <br /> APPLICATION ACCEPTED BY-----------' - --------------------------------------------------------------------- DATE-----------`---oo ----- - --- <br /> REVIEWED BY-------------- DATE----------------------- --------------!I---------- ------ <br /> ----M-----------M--------- ------------------------------------------------M--------------------- ------------- - <br /> BUILDING-PERMIT ISSUED------------------I-------------------------------------------MM--------------------------------------- DATE----------------------------- -------- ----------------------- <br /> Alsand recommendations:_ _ <br /> r'2i,�"`� � � w '1 �i'�, -------------------------------------------------------------------------- <br /> --------------- - <br /> ---------------- <br /> ---------------------M- -----------------------------MM-----------M--------------- --------- <br /> -- - ----------------- ----------------- ----------- --------------------------------------------­----- ----------- -------------------------------------------------•--------- -------------------- <br /> ------------------------------------------------------------- ------------------------------------------------------------------------------------------------M---------------------------- ---------- <br /> ------------------ ........ -- - ------------------I---------- - -I- -------- ---M------ -------- ---------------------------------------------------------------------- ----- I ------ <br /> .1 <br /> FINAL INSPECTION BY:---._..._f ---------- -------- ------------------- Dafe__­ ........ ------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Maxeltom Ave. 300 West Oak Street 124 Sycarn are Street 205 West 9th St!reef <br /> I <br /> Stockton,California Lodi, California Manteca,California TFOCY,California <br /> P.F.C Q <br />