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FOR OFFICE USE: <br /> ----- ---------------------------------------------- -- <br /> APPLICATION FOR SANITATION PERMIT Permit No. .r .----------- <br /> - <br /> -- - ------------------------------ ---------- --------- (Complete-in Duplicate) o <br /> Date issued <br /> .................. ..... ...........___ -------­------ This Permit Expires 1 Year From Date Issued <br /> .__/1- --•---6 7 <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. / A n r <br /> JOB ADDRESS AND L TION 77� ''r--.- -- 9--- �1�� �°L � �` �`�"� �°E <br /> Owner's Name------------ - - ----- --------------------------------; ----------- ---- - - ------------ ------------------------- Phone----------------------------------- <br /> Address-- <br /> -------------••----------•----Address-- I 1 'Z'2' ------ --------- - -- --- `.0 --------------------------------------- <br /> 4 <br /> . <br /> Contractor's Name c / z�---`�`----- - `. Phone <br /> Installation will serve: Residence [Apartment ouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __1.____ Number of bedroomsNumber baths._/---- Lot size __ _ __ ___ _ _____ _____________________________ <br /> Water Supply: Public system ❑ Community system ❑ Privateepth to Water Table ft F <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeB-_'Hardpan ❑ <br /> Previous Application Made: (If yes,date___________________ ) No ❑ New Construction: Yes ❑ No ❑ 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 nk: Distance from nearest well--.r1 A.._._._Distance from foundation-----bP--------Material ----- - -7c.e_�.-----r'e----- <br /> No. of compartments___-_-. . !S f q R p y. <br /> - -'�'-------Size✓--�- -- -rs�----Liquid de th----�--� � -------Ca acct z?Oa- ----- <br /> Disposa ield: Distance from nearest well._-FA_1-----Distance from foundation------ 0-r <br /> ----.Distance to nearest lot line_-_-__- <br /> Number of {Ines------------`---_--___-.___.-.Length of each line__ ___1040_.._-_--.-_.Width of trench..--,---------------------------- <br /> JI \ <br /> �j <br /> Type of filter material__. .XA......_Depfl, of filter material'___.�_f_4_ :__.:`_Total length........ Qd______.___________________ <br /> i / d <br /> See pa Pit: Distance to nearest well.....A1A.._-_----Distance from foundation---/D__.-_-____.Distance to nearest lot line-_--+-__-_...._ <br /> Number of pits--- ---/-_...._.-.--Lining materia!___._-.s t. -,_ Size: Diameter__-44-.�_---- .Depth_� �_.-_._._____- <br /> 1 <br /> Cesspool: Distance from nearest well ________________Distance from foundation----------------- ..Lining material__._..__-___...____._______.__.-__.__. <br /> ❑ Size: Diameter- -- --------- ---- ------.Depth---- -.--------- <br /> ---- -- E_iquid Capacity------ _-----=-------------gals. <br /> Privy: Distance from nearest well----_..------------------ -------.--------------Distance from nearest building______.___________.___________-_____..._. <br /> ❑ Distance to nearest lot line------- ---------------- - - --- ---------------------------------- _------------ ----------------------------------------------- <br /> Remodelingi g e):----- ------- ------------------ --------------------------------------------------------------•-------------------------------------------------------- <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, Sta ws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)------ ---- ---------------- -- ------------------------ ...._. ----------- end/or Contractor( <br /> B :._ .. Title <br /> (Plot plan, showing size of lot, location of syste in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----- Wiz. ill ------------------------------ -- ---- ----- DATE--- C T �p 7-------------- <br /> REVIEWED BY----------------------------------------- --- ------ DATE-- •---- --------------------- <br /> ----------------------------- <br /> BUILDINGPERMIT ISSUED---------- ----------------------------------------------------------------------------------------._ DATE- .----------------_------------------------------------- <br /> Alterations and/or recommendations: ----- ---- ----------------------------------------------------- ---------------_------- .......... <br /> ---------------------------------------------------- ------ -------------------------- -------------- ---------------------------- --------- ----------------------------------------------- ------ -------------- <br /> Y <br /> If ��7G7 <br /> FINAL INSPECTION __-_ Date _ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT i <br /> 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> 5tocktan,California Lodi California Manteca,California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br />