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FOR OFFICE.USE: <br /> --- <br /> ------- APPLICATION FOR SANITATION PERMIT Permit No. IJ71�` ___ <br /> ------- -------- (Complete in Duplicate) ,-------------------- - ------- p <br /> Date Issued ,/_-_IJ1 __�,i <br /> - �-- This Permit Expires 1 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 compliance with County Ordinance No. 549. x ` i �,., <br /> lf�o �J;_ DSS-/rn -Y7 <br /> JOB ADDRESS A LOCATION_��--?n�i -- <br /> ---`------••--------------- <br /> Owner's Name__ 5116 ----- •� <br /> - •---------- <br /> -- Phone--­ <br /> t <br /> Address---- - ..4. - - ---------------/--& - . ., <br />' Contractors Name-------•-- ---•----- � _ !�`v.C_---- ---- ----- .----•---•-------- <br /> ---•--. <br /> ----- - Phone--..------ - -------------------------------•---------- '- - --•- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units:.--/--- Number of bedrooms--.- Number of baths _!FLot size ----------------•- ------•-------------------- <br /> Water .Supply: Public system ❑ Community system ❑. Private [Depth to Water Table _�:. -: ft. <br /> Character of soil to a depth of 3 f <br /> - eet: Sand ❑ Gravel ❑ Sandy Loam f,�Ciay Loam E] Clay El Adobe F1 Hardpan E3Previous Application Made: [If yes,date-..------_:--_---_.) No ❑ New Construction: Yes ❑ No:p FHA/VA: Yes E] No E] <br /> IIITYPE OF INSTALLATION AND SPECIFICATIONS: `t <br /> (No septic tank or cesspool permifted if public sewer is available within 200 feet.) I <br /> Septic Tank: Distance from nearest well-----__-- Distance from foundation------___________. Materia#__._-----------_---------------------------------- <br /> ---- _ <br /> a <br /> '1 <br /> ❑ No. of compartments- Size--------------------------------Liquid depth-------;----- --- Capacity----------------------- !� <br /> --- ----- ----------- <br /> Dispos Field: Distance from nearest weli___. �f._.Distance from foundation---/.Q-.._.....Distance to nearest lot line---5 <br /> Number of linesJ-------1------------------------Length of each line------LQ_Q---------------Width of trench....'�-' --------- ------------ <br /> I <br /> of filter material--_---6l&?--------De th of .fiiter material___,-.-1_S-'_______Total length__._-_�_P_d <br /> 1 --- - --------- (� <br /> Seepage Pit: Distance to nearest well .________________---Distance from foundation---------------------Distance to nearest lot line-__--_____-___.._ 1. <br /> ❑ Number of pits_.`------------------Lining material--.-------.------------Size: Diameter----------------------- <br /> Depth ° ----------------------- <br /> Cesspool: Distance from nearest wefi-----------------Distance from foundation-------------------- <br /> Lining material--,---------------- <br /> ------------- <br /> El Slze: Diameter----- -----------------------------Depth---•------------------------------------------------Liquid Capacity------------------------- .gals. <br /> Privy: Distance from nearest well----- <br /> --------------------------------------..-Distance from nearest building -----------=-------------------------- <br /> ❑ Distance to nearest lot fine------------------ ---------------------------------------------------- I <br /> Remodeling and/or repairing (describe)---------------------- " <br /> 1 <br /> --- --. . <br /> -------------------•------------------=------------------ 1 `�` r�-. - - <br /> ----- <br /> t ---------- I <br /> - <br /> ------------------ <br /> ---------- <br /> --------------------------------=-•-------------•-------I--------------- -------------------------------------------------------- - <br /> I hereby certify that I have prepared this application=and fhat`the work will be done in accordance with San'Joaquin County <br /> ordinances, State laws, and rules and;regulations of fhe San Joaquin Local Health District. <br /> (Signed) t <br /> ------------=------------------------------=-------------�r and/or Contractor) <br /> BY ' �I <br /> ---- ---�----- - -•--- _ _{Title)--------------------------.._.-_-. ----.------- --....-_. e <br /> {Plot plan, s owing size of lot, location o_ s stem in relation to wells,buildin s,.efc., can be laced on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- -------------------------------------- DATE---g'I _�cr- __. <br /> REVIEWED BY ' 1 ------------- DATE_ <br /> - - --------------------------- <br /> 1 DING PERMIT ISSUED------- - -----=='------------------- ------ DATE------------- <br /> ------------------------------------------ - <br /> ---------------------- <br /> terattons and/or recommendations-------------------- <br /> ------------------------------ <br /> ----------- , <br /> _________________ T <br /> ---------------------------________________________--------------- <br /> --------------_--------------------- ____________ --------------------------------------------- <br /> FINAL INSPECTION BY:.___l`'- -_---- -- Date---.-�� Ar <br /> + � <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> i <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street <br /> 205 West 9th Street � <br /> Stockton,California Lodir California Manteca,CalS((ifornia Tracy,California <br /> P.CD. <br /> ES 9 REVISED&-59 3M 3 <br />