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FOR OFFICE USE: <br /> -------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> ----------------- ---------- ----------------- (Complete in Duplicate) <br /> This Permit Expires 1 Year From Date Issued Date issued <br /> Application is hereby made to the San Joaquin Local Health Disfrict for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordina549. <br /> JOB ADDRESS AND LOCATIO ___ ` <br /> � fJ --------------- -----M_*.t­_6C4_1__...k <br /> Vl - ---- -- <br /> Owner's Name_ L .�E �7-------- e+� �� ��-�_� p -----------,----------------- -----------•--- Phone--------�--,--------••---------•-•-- <br /> Address-------------�r=Y s"Z _EI4.Q .. 1�. -'"-!1__' �� �llli __L/�� _� � ----- i- ' �•�• <br /> Contractor's Name fF ----- Q `Sa { 1 �i `------------------------- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial [a Trailer Court ❑ Motel ❑ Other ®P[4AIT^ <br /> Number of living units: -------- Number of bedrooms A_____ Number' of baths --------- Lot size ___67--------- _ _____________________________________ � <br /> 1 1 <br /> Water Supply: Public system ❑ Community system E] , Private ' Depth to Water Table S�_ 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_..__.--------------) No 9 New Construction: Yes ❑ No X FHA/VA: Yes ❑ No EY <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: f}istance from nearest well _____Distance from foundstion__/�___________.MateriaL__Ann <br /> _______ _____.__ _..___.________. <br /> 200 �aL� <br /> No, of compartments--Z-------..........Size__ -�- -r� <br /> ---------------Llquld depth2__rI------------- <br /> O <br /> Disposal Field: Distance from nearest well_-_____-_----Distance from faundafion_____Z <br /> _©._____._.Distance to nearest lot line___'�+_L_/p4_f <br /> Number of lines__ ___Length of each line____ 7,S" � <br /> ----------------Width oftrench.__ �_tt_____ _________.___ r`, <br /> 11f <br /> Type of filter mate rial_44944A-------Depth"of filter material_._l__8-___._-_-__-.Total length-------ISV_________________________ t <br /> r . <br /> Seepage Pit: Distance to nearest well---/S�_--------Distanceram undation--lpQ-------Distance to nearest lot line__ZP__ <br /> Number of pits-_- -----------Lining material ` .....Size: Diamefer._3_3_1_14-__.Depth----_ZS--_______________ <br /> Cesspool: Distance from nearest well---------- ----Distance from foundation-----------------.-.Lining material------------------------------___--_ <br /> ❑ Size: Diameter--------------------------------------Depth-------------- -=-----------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well------------------ ...._______.________€____Distance from nearest b0ding------------------------------------------ <br /> ❑ Distance to nearest lot line-------------------------------- - -------- -------------------------- ---=-=-------- ----------------------------------------------- <br /> ---Al-e- ----- <br /> Remodeling and/or repairing (describe):__~ <� ~---- /r�G'�1 /fi- __.______. . <br /> ----------------- -------------- --- --------------- --------- ------ ------------- <br /> ---------------_ - ,rc ------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> 1E�-----------------------------=`-------------------------------------- _ <br /> ------------------ -- ---------------------------------- -------- ------------ -------------------- - <br /> I hereby certify thave prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, an rules and regal ons of th/San quin Local Health District. <br /> Si ned T@ __._..____Owner and or Contractor( g )••-------------------- ( / ) <br /> By= i-�'"+r--� CG(f----- -----------------------(Title)-- --------------- <br /> (Plot plan, showing size of lot, location-of system in relation to wells, buildings, etc., can be plat don reverse side). <br /> r <br /> 1 <br /> EPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------ - ------- ------ ------ ----- ---- DATE---------/a-- ,r ��.--------------------- <br /> REVIEWEDBY'-------------------------------------------- - - -------f---- --- ----------------------------------------'-------------- DATE-------)-------------------------------------------------- ' <br /> BUILDING PERMIT ISSUED.-------------)-------- -- -------------------- ----- -- - D TE --- <br /> Alterations and/or recommendations:-- -----------2 �� ` ---------------------•-•---------------------------- <br /> -•-------------------•---------------- ----------------- ------------------------------------------ <br /> f . <br /> ----------------------------- -------- -------- --4300 <br /> ---- ------------ -------- -- ----------------- --------------- -------------------------------------•--------- ------------------------------ <br /> i <br /> FINAL INSPECTION BY:..-- Date 1� =UIN LOCAL HEALTH DISTRICT1601 E.Hazelton Are. We Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.co. <br /> r <br />