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-FOR,OFFICE U E: <br /> ----� - <br /> ---- <br /> -------------- APPLICATION FOR SANITATION PERMIT Permit No. la.,-)o.. <br /> --------------­-- -- --------------------------------- (Complete in Duplicate) <br /> Date Issued ___�¢_I.3 . <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 compliance with County Ordinance No. 549. <br /> p�� 6 - ;� ------------------------------------------- { <br /> JOB ADDRESS AND LOCATION------------------8-- ... --�L�fL�._.��-�;+1-:�--•-------------------------------------- <br /> Owner's Name-----------------------------------------EL-s-�nE-e----------36 G-r�_o S ----------------- Phone_-Ll -S . <br /> Address. -(-----±_�- •�.�-�--14---�-�•-• -------------------------------------------------- <br /> Contractor's Name Name----------•--•------------•-----------------------------?'y ----------------------------•-----•--------------- ----------- Phone------- ----•--••----_ <br /> Installation will serve: Residence I' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: J____ Number of bedrooms __,3__ Number of baths �___ Lot size ------9.3--- ---- .7.2------------------------ <br /> Water Supply: Public system ❑ Community system ElPrivate ®, Depth to Water Table .4u ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,® Hardpan ❑ <br /> Previous Application Made: (If yes,date------PQ-_--) No t( New Construction: Yes ❑ No IR FHA/VA: Yes S 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 well---7QOist �roy foundation------6a Material ____.___.____ <br /> ______ <br /> � a _____ -- <br /> anc <br /> _. <br /> No. of compartments_____-_-_ . S �-Capacity_----_1� <br /> Disposal Field: Distance from nearest well__,5-0____Distance from foundation_._._Zd--------Distance to nearest lot line-------47_ <br /> Number of --------------------Length of each line_---_r?n_-----.___------Width of trench--_--- -- ... <br /> Type of filter material__Depth of filter material_______ 8 rt_____.Total length___________ : ___-_---___--_ t� <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line..........--_____ <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter---------------------- Depth---------------•----------------- \ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-__-____-_--_________________________. V\ <br /> ❑ Size: D+ameter--------------------------------------Depth---------•------------------------------------------Liquid Capacity---------------------------gals. <br /> Privy: Distance from nearest well--------------------------------------_--------__Distance from nearest buiiding__________________-----.._._-_-__-_______- <br /> ❑ Distance to nearest lot line-----------------------•---------------------------------------------------------••--------------------------------------------------------- <br /> Remodelingand/or repairing (describe):-----------------------------------------------------------------------------------------------•------------------------------------•--•---------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------• -------------------------------•---------------------------------- <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, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)_ •-------- ------------------ ------------------------------------------------------------(Owner and/or Contractor) <br /> BY:-------------------------------------------•---------------------------------------------------------- ----------------------------(Title)------------------------------------------- - - ------------ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed an reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------------------------- - __/----- ----------------- --------------------- DATE---------- �ry� �r----------------- <br /> REVIEWEDBY ----------�---------------------------------------------- DATE---------------- - ---------_-- - • ----- <br /> BUILDING <br /> -- <br /> BUILDINGPERMIT ISSUED---------------------------•-•---------------------------------------------------------------------- DATE------------------------------------ <br /> Alterationsand/or recommendations------------------------------- ---------------------------------------•---- -------------------•-•••--••-•----------------------•----------- <br /> -•---------•-----•------------- F -------------------- ------------------------- --------------------------------------•- = ---R <br /> � _t - -- - --- - <br /> E' ------------------------------------------------------------------------- <br /> � ----------------- <br /> FINAL INSPECTION BY:-- (`U r'. y( '? �-.'i� Date----------------------------- ---��- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> I ES-9 RVViBEO a-89 r.P.ro,7M a-6G <br />