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Lam- OFFICE USE: � 6 q <br /> X6,0_0-------- - /f) ,)---- -- <br /> APPLICATION FOR SANITATION PERMIT Permit No. ___-...................�� <br /> _--_- _-____._ (Complete in Duplicate) Date Issued .______.�-__ _ <br /> 7This Permit Ex ires:1 Year From Date Issued k <br /> - P q y <br /> Tha application Is made in compliance. Count Ordinance No. <br /> for a permit to construct and install the work herein described. <br /> Application is hereby made to the San Joaquin Local Health <br /> PP e No. 549. <br /> v / — it L rL -- �`c . ---- <br /> JOB ADDRESS AND LOCATION...--- ------4------"�-� - �`'� � �� � ,(� <br /> ( hone. p� G- W <br /> Owners Name------- - --�s��.�'�.-------- _ _ _ .. r. <br /> Address--------•--•---- � ���------a13------ -`�._.. 'h a ---------------------------------------------- <br /> /`` I / --------------- Phone----------------------------------- <br /> Contractor's Name--------- _f!-�� -- ----- <br /> Installation will serve: Residence [ Apartment House [I Commercial [3 Trailer Co t ❑ Motel [I Other El <br /> Number of living units: _ ----- Number of bedrooms �___ Number of baths __L____ Lot size ____-:� �'! - ------------------------- i <br /> € t th to Water Table J_�_ ft. <br /> Water Supply: Public system ❑ Community system ❑ Private Dep . - <br /> .y. <br /> Character of soil to a depth of 3 feetc Sand E] Gravel [ISandy Loam B-­tlay Loam ❑ Clay [3 Adobe❑ Hardpan ❑ <br /> Previous Application Mader (If yes,ddte--._..-_.-,--__---) No Z]/1VQw Construction: Yes 1! No ❑ FHA/VA: Yes E] No <br /> F <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> I �ry ---- -C-� ----- <br /> �/ No. of compartments-----------�-- ....__Size.. 'Y4 -------Liquid dep. h ---�� Capacity-----yeo: <br /> Disposal Field: Distance from nearest well._ .......Distance from foundation-----/_(-____-...Distance to nearest lot line_____ <br /> Number of lines-- - Length of each Ine_-- Width of trench. <br /> --_-----. -:- k , lj�--- -__? ----------------------- <br /> ----------- <br /> Type offfilter material Depth of filter material.__1176_______;__._Total length______�rr '__1_`C��----- <br /> Seepage Pit: Distance to nearest well____ __________________Distance from foundation________.____.___.Distance to nearest lot line----------------- <br /> ❑ Number of pits.-:#----------------Lining material--!____..__.---y-----Size: Diameter-----------------------Depth--------------------------------- <br /> A <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-----.--------------Lining material-______._.__._-____._-_---______.__. <br /> ❑ Size: Diameter-----I----- - Depth `----------------- --------- - ----------------Liquid Capacity-.--------- ----------------gals. <br /> � k <br /> Privy: Distance from nearest well------.__.-___.-_.._�-_:f -_Distance from nearest building________________________________.._---._. <br /> ❑ Distance to nearest lot line----- ¢= ' -------._.. -------- '7 <br /> ------------------------------- <br /> Remodeling and/or repairing (describe:----------------•--------------------�---,f• ------. <br /> •-----------------------------------------` ------ <br /> 't ----------------------------------------------------------- <br /> ---------------•-- --------------------_---- ---------------------- <br /> 4 <br /> ' --------------------- ---------------------------- <br /> ----- <br /> - - - -- --•--- -`---- ------ --- <br /> ! 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 t@6 tan Joaquin Local Health District. <br /> {Signed)_` .._ ZZ - '� ._ I <br /> Owner and or Contractor <br /> € - • - -----------(Title)-- ------- - ----------- --------------- <br /> By_-------------------- ----------------------------------------------------------- - - <br /> (Plot plan, showing size of lot, locafion of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY..... <br /> REVIEWED BY--- ------ - ------------. /� G -- DATE 4� �� c,/ <br /> I DATE-------- - - / <br /> - ---------------------------------- <br /> BUILDING PERMIT ISSUED---_------------ -------------- ---------------------------------------------- DATE <br /> Alterations and/or recommendations:_�.=,?--& �------- P <br /> ��e = ---------------------------------------------------------------------------- <br /> -------------- -----------------------------------------•------------ <br /> e <br /> ----------------- <br /> -------------------------_________________________—_.___.__________...___..___ <br /> __________________ r_---------_----------- <br /> .__. ____________________________________________________________________________ __________..___--- . <br /> FINAL INSPECTION BY' -- - ------ ------------ s Date.-.--- -�` ------------------ --- -------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> k <br /> 1601 E.Hazelton Ave. 300 Wesf Oak Streel 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />