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FOR'OFFICE`USE: 4 <br /> --------------------------- Permit No. <br /> �l <br /> APPLICATION FOR SANITATION PERMIT l <br /> - a_ <br /> (Complete in Duplicate) Date Issued <br /> ------- ----------- ------------_.-- ____.--__--_ This Permit Expires 1 Year From Date issued P?`7 Z— <br /> Application is hereby made to the San Joaquin.Local Health District for a permit to construct and install the work herein described. I <br /> This ap pplication is made.-in com ' nce with County Ordinance No. 549. n�TC <br /> JOB ADDRESS AND LOCATION_S(.f'�,F_= /--� <br /> __ N H-------- �--------=�O------- J t ---. <br /> Owner's Name--------- --------- ]CY ---------- -------------- Phone--------------------- <br /> ----------•--- <br /> .. _ R <br /> .------- _ � <br /> Contractor's <br /> Name----.-OUJA5� ,-----------I-I-------- --- ------ Phone--------------------------==- `='--- <br /> Installation will serve: Residence ❑ Apartment,House ❑ Commercial ❑ Trailer GovrF 0- Motel ❑ Other ❑ <br /> Number of living units: ---(__ Number,of bedrooms _ Number of baths _-___ Lot size ___________________________________._-_____________----_-. <br /> Water Supply: Public system-❑ Community system ❑ Private 0---Depth to Water Table _: _ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loamm [ lay Loam ElClay ElAdobe E3Hardpan ❑ <br /> Previous Application Made: llf yes,date__________________ I No� New Construction: Yes ❑ No []—FHA/VA: Yes ❑ No E] <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 LL-54'_-___Distance from foundation-------f/9----- Material_---o.%VCR_Z�_T ---------. <br /> /y Capacity Liquid depth__._.___ . ----------- <br /> Disposal <br /> O <br /> ❑ No. of compartments----=-�------._Y-;`------Size- ---x--- --x ------- / �:.,�---Ca out ,. <br /> Disposal Field: Distance from nearest well-_-, Q....Distance from foundation-___f -------Distance to nearest lot line_ __---�_____._ <br /> Number of lines______---__(11.� ___Length of each line______ __��.__.Width of trench___.___: !s_ __...-___r_.__ <br /> Type of filter material-1)3 _C��___Depth of filter material-__-.-_f_ _________..Total 'length____________________�_� _______.-_-- <br /> t <br /> Seepage Pit: Distance to nearest well__-_-.'_____________Distance from foundation--------------------Distance to nearest lot line______.___ f <br /> El Number of pits------------------ Lining material---------- ------------Size: Diameter - Depth <br /> Cesspool: Distance from nearest well _'-_______..._Distance from foundation----------- _ <br /> _______ _Lining mate' _ __ <br /> rial_-- ________-.---__._-.---_ ._--- { <br /> (� Size: Diameter Depth ---------------'Liquid Capacity gals. { <br /> € <br /> Privy: Distance from nearest well------------------ -------- ----- - ......Distance from nearest building----- ------------------- ------ <br /> ❑ Distance to nearest lot line-------- ------------------- -- ------------------------------ - <br /> a �V - <br /> Remodeling and/or repairing (describe):--------------------------------- ---------------------` ` =- -------------------- -------------------------------------------------------------- <br /> ------------------ --------------------- -------------------- <br /> --•----------•------------------------------------------- -` 0 ---------'-'------------- - <br /> ----------------`--------- ----------------•-- -•-------------------------------------------------- <br /> 1,,., <br /> ------------------------------------------- ---------------- ------------------------------------------------------ '------------------------------------------------------- ------------------------------------ ....... <br /> I hereby certify that I have preparedthis application and that the work will.b�e done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Heal#h District. <br /> (Signed) C ' (Owner and/or Contractors- j <br /> Title _ <br /> --------------- <br /> ----------------- <br /> } <br /> (Plot plan, showing size of lot, I co ation of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY { = = DATE- ------------------ -- <br /> REVIEWED BY.-------------- ------------- DATE - <br /> BUILDING PERMIT ISSUED------ ------- ----- ---------------------------------------------------------------------------- <br /> - - --------------- DATE.------------------------------------------ ----------------- <br /> Alterations and/or recommendations:------- ------ ----- --------------------------•----------------------------------------------------------------------------- ---- <br /> a N 1471 -;'1t1 1 <br /> ------------------ ------------------------------------------- - -- --------- ----I-------------------------------------- ----------------- --------- <br /> ------------ -- - -- -- ------------------------------------------------- <br /> FINAL INSPEC BY:_- -- ---- Date----------- ----- zo ----- -�------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi.California — Manteca,California Tracy,California <br /> F.P.co. .,, <br />