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FUK Ut-HU USE: <br /> ------------------------ -------------------------------- <br /> -------------- ---- ------------------------------------ <br /> --------------------------------------------- ----_------.----.---..--.--.-._______-_. APPLICATION FOR SANITATION PERMIT Permit <br /> --------------------------- -- ---- -------------------- (Complete in Duplicate) <br /> - This Permit Expires 1 Year From Date Issued Date Issued <br /> 2LF!- osz_a-b <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-Vo. 549. E A4TCt <br /> k-6 <br /> JOB ADDRESS AND LOCATION... -- --�PT, P-- - ----- - ,/ /.S.!!°- ----------- <br /> Owner's Name----(/----� I <br /> Address-------/0_ iJ6------ J1p _iP !. a <br /> Contractor's Name------- -------�4?(p- ------- ---r------------------------------------------------------ Phone--9��,���P-fM--- <br /> Installation will serve: Residence partment House ❑ff Commercial ❑ Trailer Court ❑ Motel ❑ Other E]Number of living units; -------- Number of bedrooms _--L Number of baths __Z__ Lot size -_. - ~x----1 ---_-.--_------_--_.-___--.- <br /> Water Supply: Public systef ❑ Co munity system E] Private [Depth to Water Table/d' --- ft, <br /> Characterof soil to a depth of 3}feet: Sand ❑ Gravel ❑ Sandy Loam [Clay Loam ❑ lay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made:s (If yes,date--------- ----------) No 0:2, New Construction: Yes [ lO❑ FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> SepOXnk: Distance,,from nearest well__S '!'%Distan il�erfrom4olu dation--lD--_--------.Ma#erial__4/>C�`­1� - <br /> No. of compmets-. . Size- 1 -- ----Liquid <br /> ddepth----- ------------Capacity--1 ?iQ----- <br /> Dispo Field: Distance from nearest well___ Distance from found ion._l;j--__-.------Distance to nearest lot line------ _---- <br /> Number of lines-- - - Length of each I'rn - .Width of trench----- _-.- - � r�t1 <br /> l► <br /> Type of filter material- _ A���L.-...Depth�of.f�ilter material-� ----------------Tot I length----_.fQ--_-.-.-._--------------_ CN <br /> - <br /> Seepage Pit: Distance to nearest well----- -------- ---Distance from foundation-------------.------Distance to nearest lot,line-------._--.---• <br /> ❑ Number of pits--------1-------------Lining material------ ----------------Size: Diameter---------- -----------Dep#h-------------------------------_- (+� <br /> Cesspool;-t 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,building___--------------------------------------- <br /> 0 DistanceZto nearest Iol lip --- ------i%--.-—-- --- �-------------------- ------- .. ---------------------------------------------------- <br /> Remodeling and/or repairing S -l�,l- at-n---------------------------------------------------------� <br /> -----------•----------- - ----------------/-----� = <br /> I- f Y <br /> ---------------------------------------------------------------I---------------- --------• /-- --• I <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 nd regulations of t'he�Sari°Joaquin Local Health District. d <br /> (Signed) ------- ----------- ----------------------------- T _(Owner and/or Contractor) <br /> BY:----------- <br /> ----------------------------------- _=---- - - Title P'7 � --- <br /> Y ( } f <br /> (Plot plan, showing size of lot, location of system in relation to well?;,"buildings, etc, can be placeZon reverse side). <br /> FOR DEPARTMENT USE ONLY,; f i <br /> APPLICATION ACCEPTED BY Tc, �O. _.. -- <br /> ------ ------ ------------- DATE__:`-------�-~--397-67 <br /> REVIEWEDBY------------------------------------------ -- --------------------- --------------------------------------------------------- DATE-_-------------------------------------------------------- <br /> BUILDING <br /> ATE- •-------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED------------- ------------------------------------ -----------—-------------------------------------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:----------------------------------------- ----------------------- ---------------------------11 <br /> ------ <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------ ------=---------------------------------------------------------- <br /> t , <br /> ---------------------------------•-------------------------------------- ----------- ----------------•-- ----------------- -------------------------•--------Z....... ----•---------------------------------------------.- <br /> r, *- <br /> i�----5- ---------------- ------------------------- <br /> FINAL INS Da#e ------ " .-44 <br /> ------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hozolton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />