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fOR OFFICE USE: <br /> --------------------------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit NO., .lX3._;�.�`..... <br /> -------------------------------------------------- ----- `� (Complete in Duplicate) 4 r <br /> ----------------- ---------------------- ------------------ This Permit Expires 1 Year From Date issued Date Issued /n?/ <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. 50. <br /> ionf JOB ADDRESS A LO TION.... I -�-----------•­----------------- -- = K_�"=----------------------------------------------- <br /> Owner's Name- f � rC Phone--------------------•---•--•---•---- <br /> -------- -- - <br /> Address <br /> ----- ----- <br /> Contractor's Name-------- <br /> :1-:v Phone <br /> Installation will serve: Residence [� pA aarrfinent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living}units: -- ---- N ber of bedrooms __._'Number of baths __ Lot size --_-. _�~. __. <br /> Water Supply: Public system ; Community system❑Private ❑ Depth to Water Table _,6,?ft. <br /> Character of sail to a depth of 3 feet: Sand-E] Gravel ❑ Sand am E] Cla` Loam E] Clay E] Adobe hardpan ❑ <br /> i <br /> 'Previous Application Made: (If yes,date � --) No New Construction Yes ❑ NoHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitfed if public sewer is available within 200 feet.) <br /> Septic Tank: Distance,fr•om�nearest well_--____:?::_:_-_Distance from foundation--._-A""- -------LMateria.l------------------------------------------------- <br /> ❑ No. of compartments- - ---------------I.....Size--------------------------------Liquid depth---------------;---------.Capacity------ ---------------- <br /> Disposal ield: Distance from nearest well....�"":__._Distance from foundation: _ --:__--Distance to nearest lot line__.- \ <br /> - ----------- <br /> Number of lines______.----1......_._ { Length of each line_____[_ _`_f__ �........ Width of french <br /> Type of filter material_T _�j ___ `'`bepth of filter material._---1-1-9--_------Total length____-Y--- /_______________________ <br /> Seepage Pit: Distance to clearest well._____________________Distance from foundation-------------------Distance to nearest lot line--------_-_--...- <br /> . <br /> ❑ Number of pits--------- <br /> y.'!..'__Lining material-----------------------Size: Diameter-------S----------" - Depth--------------------------------- <br /> Cesspool: Distance from r earest we l-----------------Distance from foundation____...__._-_-.._..Lining material__.__ .._.__ ---------------------- <br /> ❑ Size: Diameter.—_.R =---------------Depth---------------------------_--�c--. Liquid-CapacTtY gals. <br /> A <br /> Privy: Distance from nearest wO ------------------------------------------------ <br /> Distance from nearest building___ _. .-..-----_-------_--_-_..____--__-- <br /> Disfance=to.-nearest lot.line-... `- w <br /> ry. x <br /> Remodeling and/or re.p icing (describe):--------- ( ' 4 -� <br /> P <br /> �� <br /> I hereby certify the't'I heve�prepa�ed-thi application ani+hat+he work wtll�be done-in accordance with San Joaquin County <br /> ordinances, tat a an rules a u a�fions o the <br /> San Joaquin LocalHealth District. <br /> ---------- <br /> (Signed)--------------- � ----- -- -- (Owner and/or Contractor <br /> ) <br /> 4 <br /> By:-------------- ---- = - --f---------------------------(Title)--- ------------ <br /> (Plot plan, showing size-. o ocation of system in relation tow s-bfrtfdings, etc., can be placed on reverse side). <br /> � 3 A <br /> i FOR-DEPARTMENT-USE-ONkY— =_ -- - - <br /> 4 <br /> APPLICATION ACCEPTED BY----------------+~ '.___ DATE 7�r <br /> .17Y, <br /> --------------------- <br /> REVIEWED BY------------------------------------ - ------ DATE--------------------------------# <br /> BUILDING PERMIT ISSUED-------------------- -- --------------------------------------------------------- DATE--------..---------- t <br /> Alferafions and/or recommendations:----------------------------------------------------------------:----------------o--------•--------------•------- *----•-------------- ------ <br /> li. y <br /> ----------'-----------------------------------------------------------`r---------------------------.-.-----------------------------------.------------------------------------- ------------------------------------- <br /> --- -----------------'--------------------------------------------------------------__-----------------------------------------------.-------------------------------------------------------------------------.------------- <br /> -------------------------------------------.-----------------------------------------------------------------------------------------------------------------•---------------------------------------------------------------- , <br /> k 4 <br /> FINAL INSPECTION BY:. .. y:'-------------------- ------•------------------ Date --------------------- -- <br /> SAN-JOAQUIN LOCAL HEALTH DISTRICT <br /> N .. e <br /> 1601 E.Hoielten Ave. 300 West Oak 4Street { 124'Sycamore Street 205 West 9Th Street <br /> Stockton,California Lodi,taliFornia F. k 1.4Manteca,California Tracy,California <br /> F.P.r O. <br />