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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT Permit--.No. fis:: f <br />- --------------------------- - -------- ------ (Complete-in Duplicate) <br /> Date Issued ,-2- <br /> -- - ------ ----- ---------------------- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. <br /> This application is'made in compliance with County Ordinance No. 549. <br /> } i1 �JOB ADDRESS AND..LOCATION-.--- ----------- ------�.-----�`------ 0.E ...... --------------------- <br /> Owner's Name ITS , Z0.- Q ' 4� -------------_-- <br /> Address <br /> r�- �5 <br /> . r <br /> ------------ ------ - Phone----- -- - <br /> Address-------------- ------ - Ga..9C` ' --------- -•-------------------------------- <br /> Contractor's Name------ -••-- . ------------ ---------- - ------ ------ Phone------............................. <br /> Installation will serve: Residence.M i'Apartmen House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: j---- Number of bedrooms. Number of baths__1----- Lot size __..39 _�-+ . Qr___ <br /> Water Supply: Public system Com mm niy system ❑ Private ❑ e-pth to Water Table ...... _ ft <br /> Character of soil to a depth of 3 feet- Sand Gravel ❑ San�( Loam Clay Loam El ClaY� Adobeg Hardpan <br /> ❑ <br /> Previous Application Made: (If yes,date........._".r— --),_Nopt:~�New Construction: Yes ❑ No FHA/VA: Yes ❑ l' Q' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: i W <br /> (No septic tank or cesspool permitted if seweris available within Rti feet.}:—�£ <br /> Septic Tank: DisNo Corn nearest well................ Dist�ce from foundation - ;de th .Material ----------------------------------------- ------ I <br /> t L,JU <br /> ❑ t p ent Size -`i' " ' q P Capacity <br /> Y, [ Al ' � � <br /> Disposal Field: Distance from nearest .well lye..._Distance from foundafion_.__!0____F._.Distance to nearest lot line___jd...__... <br /> Number_of iinesr_-0._____-r_._�. i -------Len Length of eat hlined%;--�..�/D_j�+,-_-i---Width of trench------ - -��----------._ <br /> Type of filter material-1, -!_�®_ct-__Depth of filter.mater.i 1' f'�,~ _..Total length-------dJQ---------------------------- <br /> See <br /> ______________ -_-__. <br /> er-- r I <br /> 5eepe Pit: Distance to nearest well..�a/X4.-.-.Distant ­fro�n found lon_��-A ..........Distance to nearest lot line---lQ_____.._ <br /> Number of pits--- - ----------_ Lining_materiSize: Diarrief r''_._ --------Depth......... ---------- i <br /> Cesspool: Distance from nearest well ________________Distance from found atian_�` �._"._!_ ..Lining material_______-._._____.._.____..______-_-_.El ` <br /> Size; Diameter. -- s------------ - -- - - ----- Dept h__............._------------ - Capacity-..,.-. <br /> gals. <br /> Priv Distance from nearest well------------------------------_.-.-___.-.-_-__.._Distance,rom nearest building ---_--------- --_ <br /> ❑ —Distance-to-nearest-lot-iin_e ---------------------------- - ------------ ------------------- <br /> Remodeling <br /> ----------•-Remodeling and/or_ repair•ing-(.descr.iW:---_----____ * :*-___ ______ <br /> -------------------------------•------•-------------- ! -- ------------------ 1 <br /> 1� I <br /> kl <br /> -----------------_____________________________________________�____--_._-__.-_._-__________________________________.____________._-______--_--_________________.______-_-________.._.__.._____________-____._.. <br /> Lr <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joa County <br /> ordinances-State laws, and rules and!'r gula#ions of the San Joaquin Local Health District. <br /> � r � <br /> (Signed)--------- ---------------------------------------------------- ------- ------ { .� <br /> -- ------- - ---------- ---- Title ------ - - ----- - --------------------- <br /> (Plot <br /> -------- -- -------(Plot plan, showing size of lot, location"of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> it <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------- r r- - ------------- ------ -------------------- ---- -------------- DATE- <br /> REVIEWED <br /> ATE REVIEWED BY-------------- I --- - -----. DATE-------------- = <br /> = - <br /> BUlLDING PERMIT ISSUED. -E---------------------------- - DATE. <br /> Alterations and/or re me ations--------------------------- ---------- --- --------------------- ---------------- --•-----------•- ------ <br /> 7: ---------- -- - - - <br /> ----- ----------- - --------- - ------------------------------------------.-----.------------------------------------- <br /> ---------- ------ ------ -------- -- -------- -- ---- --- --------- - --- `--------- I <br /> --------------------------------------- <br /> ------------------------------ --- -- -------------------------- <br /> FINAL INSPECTION BY:..------. Date--- _e� _—_1 , <br /> t SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haz*lton Ave, 300 west oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi. California Manlecs, California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br /> i <br />