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FOIA OFFI E USE: <br /> -_.�k1b). __j APPLICATION FOR SANITATION PERMIT Permit No. ....1 _ .. <br /> -------------- ------------------------------------------ (Complete in Duplicate) <br /> Date Issued <br /> "This Permit Expires 1 Year From Date Issued <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. 549. <br /> JOB ADDRESS AND LOCATION- . ---------- <br /> ----------------- <br /> Owner's Name. `` /fir ? � - - ----- --- --------------------------------------------------•------------------------- Phone <br /> Address_. ... u! T --- <br /> Contrac:tor's Name--------------- .._.. Phone---...... ......-•--------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -./_ Number of bedrooms 9--- Number of baths ___Z_ Lot size ._ ► p_f_____________________________ <br /> Water Supply: Public system ❑ Community systemPrivate ❑ Depth to Water Table <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ <br /> Previous Application Made: (If yes,date--------------------) No ET"_New,Construction: Yes gj-'No ❑ FHA/VA: Yes Z]�'No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> i <br /> Septic Tek: Distance from nearest well----___ '---Distance_from foundation__/Q----------Materl__�r_(�_ __-___--__. <br /> Er No. of compartments-----Z-- --- depth------ _/----------Capacity--- 4115------- <br /> r <br /> Disposal Field: Distance from nearest well----=----_Distance from foundation_/11;�7____.......Distance to nearest lot line_.J.-______- <br /> [7� Number of lines-------,--- _ Length'of each line_____ -------Width of trench-- -- ______,_�__________________ <br /> Type of filter material/t;rLet<Af__Depth of filter mate ria �!________Total length------1.XV__ ___________________ <br /> Seepag�it: Distance to nearest well-----___.___.__-____Distance from foundation__../p.........Distance to nearest lot ----- <br /> 12311, <br /> Number of pits_- _ Z------------Lining material__ .Size: Diameter__ <br /> ' _ Si,- S.;j�......... ------------------ <br /> Cesspool: Distance from nearest wed-----------------Distance from foundation__.._r.___________-Lining material___.____.,_.____________-__-._-.___-. <br /> ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----__._________________________________ <br /> Distanceto nearest lot line----------------------------------------------- -•------...._............--------------------•-------------------------------------�-- <br /> Remodeling and/or repairing (describe):----------�- � - ----I-•------ ----------------------------------- <br /> ----------­­-------------------------------------------------------------------------- <br /> -------•------•--•--•-•------.------•--•--------------------------------------------------------•------•----•--------•------------------------------------- <br /> -----------------------------------------------------------------•-------------•--•---• ---------------------- -�--•------------------- <br /> -------------------------------------------- --------------------------------------------•---------------------------------•----------------------------------------------------------•------------------------------------- <br /> I 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 the San Joaquin Local Health District. <br /> (Signed) Contractor <br /> ------------------------------- - <br /> B ----------------- - -- --- --- Title / ------- - -- - --------------- <br /> (Plot plan, showing size of lot, location of syste in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-..--4'.' <br /> Y_.__ _. <br /> -- -s----ref -- --- - - -- -- -_•--------------- DATE--- - c�---`-1--"--�--�------------- -- <br /> REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE-----------..-----•-----•----------------------------------- <br /> BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE---------------- <br /> ------------------------- •-------------- <br /> Alterationsand/or recommendations--------------- -- ---- ---------------------- ------------•---------------------------------------------•-----------••--•------------ ---------------------•- <br /> -•-----------------------------•---------------------------`------------ ----------- -------------- ----------------------•--------------- •- <br /> --------------------------------------------- ---- --------------------------- •--­­----------------------------- <br /> FINAL INSPECTION BY:-- - Date.--------MF...7-..1?--L-1�--.1f---------------------------- - -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> Fs-9 REwspp a-59 F.P.M 2m 6.60 <br /> i <br />