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_OR OFFICE USE: <br /> ....................... <br /> s h. <br /> ----------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. _�`.. .i . <br /> (Complete in Duplicate) 7 <br /> ---------- <br /> --------------- --------- ------ --- ------------------" Date Issued -------=---���� <br /> _._..____"_______________ -. This Permit Expires 1 Year From Date Issued *0�''� �� <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and�instalFttl�e�ori herein described. <br /> This-application-is-made„in._compliance wit4.County Ordinance No. 549. <br /> Of <br /> JO ADDRESS AND SOC ION 1 . •------------ <br /> � f r <br /> Owner's Name---•-- F-- R ---- - - Phone----_----------------------------- <br /> Address.- . ? < f_ �• <br /> -- --------- <br /> I <br /> Contractor's Name------------ .� L•Ev--------------------- -------•--------------------._. Phone------------------------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: Number of bedrooms,,_._ Number of baths AL_._ Lot size _ ---__________._____-___-_____ <br /> Water Supply: Public system ❑ Community system ❑ Private 2?---'Depth to Water Tablej ft. <br /> r i <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe lardpan ❑ <br /> Previous Application Made: (If yes,date-------------"......1 No PR' New Construction: Yes �o ❑ FHA/VA: Yes No ❑ <br /> TYPE OF INSTALLATION AN SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 240 feet.) <br /> fes.i i r• <br /> Septic Tank: Distance from nearest wA__. _____Distance- from foundation__Z2` 7 .__..MateriaL_,�_�_ C"<'-__:___ ------------ <br /> No. of compartments___wY________________ _Size XW`�VW Liquid depth__."�--`-------------Capacity�� ------ <br /> 40— � <br /> Disposal Field: Distance from'nearest well_ _.__Distance from foundation__ _-_____-.Distance to nearest lot line_____________ �J1>I <br /> Number of lines-------�___________ _______Length of each line__ f---------------Width of trench.,_-.------`---_-________-____ <br /> Type of filter material/_f./6i -Depth of filter material___ ---Total length____ <br /> o <br /> Seepage Pit: Distance to nearest well___'` �!_--___Distance fr m fo dation_--,f'. -------Distance to nearest lot line.,_,� --------- <br /> Number � .v <br /> � Humber of pits________________Lining material_ _ _ -�_______-Size: Diameter.�_�.±_-e __.-__-Depth_.-_ .4�.: <br /> Cesspool: Distance from nearest we!€-----------------Distance from foundation___________________lining material----".-.-._____-____-___.____________ <br /> ❑ Size: Diame er--------------------------------------Depth----------------- -----------------------------Liquid Capacity---------------------------gals. L <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ <br /> ❑ Distance to nearest lot line---------------------------------------------- --------------------------- ---------------- <br /> F <br /> Remodeling and/or repairing (describe):-------- ' ' - _ '�� `------------------------- -•----------------- ls' <br /> ----� ----- ---- ---------------—--- ----------------- -------.-------------------------------------- -------------------.------------ ----------.--------__ --------------------------- <br /> •' 4 <br /> I hereby certif that I have prepared this .Pp <br /> a lication 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. {fl <br /> (Signed).------------------------ - ----- --- ----- " - --- -- ;----------------------------------------------(�r Contractor) <br /> r <br /> Title -• <br /> (Plot plan, showing size of lot, location of system in anon to wells, buildings, etc., can be placed on reverse side). <br /> t FOR DEPARTMENT USE ONLY <br /> APPLICATION"ACCEPTED BY----- ------- -----%tk-bL_:V--------------------------------------------------------- DATE----I --------------------------' ' r <br /> REVIEWEDBY------------------------- ------ ------------- -------- ------------------------------------------------------------------- DATE----------------------------------------'---- <br /> - <br /> --------- <br /> BUILDING PERMIT ISSUED-------------' . -= DATE- <br /> ,. <br /> - ----' <br /> SAlterations and/or recommendations:_ --------- <br /> -------------�" ------ ----- .---- -.-----------------------------------------------------•-------------------•----------•-------------- C r- - ----------------- 1 <br /> ---------------------- ---- ---------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------- --------- <br /> A <br /> FINAL INSPECTION BY:' Q' DateP.-------------------------------- ----------- ---------- ; <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1861 E.Hazelton Ave. 300 West Oak Street i 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br />