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` FOR OFFICE USE: �7 <br /> -'l-7 147 ---- Permit No. rt -3 <br /> ------ --------- <br /> APPLICATION FOR SANITATIONPERMIT <br /> (Complete in Duplicate) Date Issued � - <br /> k This Permit Expires 1 Year From Date Issued <br /> f Application.is 4 ereby made to the San Joaquin Local Health District for a permit to construct and instali the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. ��� <br /> f 3225 . �c.arBOSr� 4-o <br /> g,r� X � � .r �t----------- <br /> IV-0 <br /> JOB ADDRESS AND LOCATION ` .�d�-R <br /> Phone <br /> 's Name__ <br /> .e ------------� --- <br /> Owner = � <br /> �y <br /> 1 11- <br /> Address--` -" --- ------r-- ------------- -- = <br /> 11�Contractor's Name `=-r S Phone----------------------------------- <br /> Motel Other ,�,/ <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ ❑ LAS <br /> Number of living units: _---_-_ Number of bedrooms _ Number of baths <br /> Lot ssze __________________ <br /> Water Supply: Public system ❑ Community system ❑ Private �pth to Wafer Table 6pft. <br /> Adobe El <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel [_1 Sandy Loam El Clay Loam [I Clay ❑ Hardpan <br /> Previous Application Made:• (If ye"sl,date--------- No �ew Construction: Yes.El'I ❑ FHA/VA: Yes ❑ 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 welilo -4" _Distance;from fpuny lion__:1?____...__._Material_____________________________________19 __ _ <br /> No. of compa'rtments__�___.____----------------- Size_. -'C '�-`5------Liquid depth ------------ ---Capacity--c+�-- <br /> il <br /> I <br /> Disposal Feld: Distance from nearest well"-I®0.''f--Distance from foundation Ia--------------Distance to nearest lot line ________.. <br /> 7 .� , <br /> �- " <br /> Number of lines----�-------------------------Length of each line__.---sS---_- --y---------.Width of trench------ I.;,------ --- --- <br /> I Type of filter rnaterial___T1�_G --Depth of filter material___ _- Total length______1L5----- <br /> j N <br /> Seepage Pit: Distance to nearest well__I00_-_�_.-Distance from foundation__/__O_________-Dista�ce to nearest lot line__�..j------- <br /> - . ------ Depth_._.---- <br /> + Number of pits-----I-_______________Lining material- -Size: Diameter___j3- <br /> Cesspool: Distance from, well_________________Distance from foundation---.----------------Lining material_.___.___--______._--________.._.-- <br /> De th Liquid Capacity- --------------------------gals. <br /> ❑ Size: Diameter- ----------------------- ---- p <br /> FF ________________Distance from nearest building--------------------------__----.-------- <br /> Privy: Distance from;nearest well <br /> to nearest lot line-------.-------------------------------------- <br /> Remodeling and/or repairing (deicribe)____________________-_ . <br /> ------------------------------------------------•-------------------------------- <br /> --- ----------------------------------------------- ------ <br /> ---------------------------------------------------------t--------------------------- <br /> -------------------------------------------------------------- --------------------------- <br /> ------------------- <br /> l ------------------------------------------------------------------------------- <br /> ------------------------------------ <br /> l hereb certif 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 g01 ul ' s of the an J aquin ocaI Health District. <br /> -------------------------------------(Owner and/or Contractor) <br /> (Signed) - <br /> Tltle <br /> ------------------------ - <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY__:�.__.____ d- <br /> ------ -------------------------------- <br /> DATE--- --7- --- --- ------ <br /> REVIEWED BY--------------------------------t------------------------ -----------< ------=- ------------------------------------------••- <br /> DATE----- ------------------- ---------------------------------- <br /> BUILDING PERMIT ISSUED ----------------- <br /> -------------------------------------- DATE----------------------------- ------------------------------- <br /> Alterations and/or recomrrtendat ns- --------- -- ---------- -- --- - ---- -----------------------------------------------•------------------ <br /> - -- <br /> ---- <br /> ------------------------------------------------- <br /> --- <br /> ------- --------------- -- -------------------- ---------------"------------------------ ------------------ ------- <br /> f , <br /> --------------------------------- <br /> FINAL INSPECTION BY:........ -- -- `:: - <br /> Date---------- <br /> ( SAN JO IN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Lodi,California Manteca,California Tracy,California <br /> Stockton,California <br />