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FOR OFFICE USE: <br /> ------------------ /-'a <br /> I cl-r-, -- APPLICATION FOR SANITATION PERMIT Permit No. . - ..... <br /> ------------------------------�-- 5..-------- (Complete in Duplicate) ] / <br /> t bate 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 /> Owner's Name_,FY T`� PrYt., Phone <br /> I <br /> - <br /> AddressA k� h----------------------------------------------------------------------••------------------------------------------------------------•----------- <br /> Contractor's Name-----......s 'rl'Q---�3e----44------------------------------------------- ----------------------------------------- Phone----------------------_---------- <br /> Installation will serve: Residence Ut `Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: --..1 Number of bedrooms -/----- Number of baths Lot size _..-�`��-'2-��-------------------------- ' <br /> Water Supply: Public system ❑ Community system ❑ Private [ Depth to Water Table <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 2�— New Construction: Yes [T­No ❑ FHA/VA: Yes ❑ No 21' <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 well_' .......Distance from foundation--GP.--.r-------- Material... --------- 1 <br /> No. of compartments.___-..----------Size------`. _�C_ .`__--Liquid depth...I----------_----...Cepacity.. '.4 f------ <br /> ir <br /> Disposal Field: Distance from nearest well_ ----Distance from foundation---- .......Distance to nearest lot line................. <br /> Number of lines-----------t--------------------Length of each line- '1�_.r- --------Width of trench-----94 ----._ <br /> Type of filter maferial_'7_0.f-.4--.-_-_Depth of filter material...1$'-a --------Total length-._.-0*0-------------_._.--------- <br /> Seepage Pit: Distance to nearest well_______..............Distance from foundation------------.-------Distance to nearest lot line--------------- <br /> - <br /> ❑ Number of pits----------------------Lining material---------------.-------Size: Diameter-----------------------Depth------------------------------=. <br /> Cesspool: Distance from nearest well.................Distance from foundation.--------------------Lining material-----------------------------------C <br /> ❑ Size: Diameter--------------------------- -- -------Depth------_----- ------------- -----------------------Liquid Capacity----------------------------gals. .I <br /> Privy: Distance from nearest Well----rr---- -------------------------------------Distance from nearest building-------------------.--------------------- <br /> ❑ Distance to nearest loft line--------------------- ------------------------------------------•---------------------------------------------------------------------------- <br /> Remodeling and/or repairing ,(describe):------- -----------------------------------------------------------------------------------------------------------•---------------- ------ i. <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, nd rules nd egula 'ons of the San Joaquin Local Health District. <br /> (Signed)---------------- _` . '---------------------- ------------------------ ------------- -----------------------------------(Owner and/or Contractor) <br /> By----------------------------t -------------------- -----�---------------------------- ----------------------I-------- -----(Title)------------- ------------------------- -- ----- ------ <br /> (Plot plan. showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> � f <br /> FOR DEPARTMENT USE ONLY <br /> l APPLICATION ACCEPTED BY....___.. <br /> --ti DATE <br /> � 7 <br /> REVIEWEDBY---------- ---------------------- - - ------ -------- -------- DATE <br /> BUILDING PERMIT ISSUED---------------------------------------- --------------- DATE-- - -------------------------- ` <br /> '' �J C> �-----( .....P ,-----c_---- <br /> Alfierations an or recommendations:.-...__'-_- L ----------------- G----1._-- - ----------- <br /> --- <br /> - - <br /> �U � <��-r -4__ -� C z��'c� ----rte �=``K'�- - •---'4 -----------------------• . <br /> �— <br /> `= ---------------- ------------------------ " r <br /> i ~ <br /> - --------------------------- <br /> -------------------- <br /> - --=------------------------------------------------------------------------------------------------------------------------------------ <br /> I <br /> ------------ ----------- ---------- ------- ------------------ -- --------- ------------ ----------------------------- - -------------------------------------------------------------------------- ! <br /> FINAL INSPECTION BY:.._/,-- Dafe-------- . <br /> ------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> i <br /> 1601 E.Havellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Stree' <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ... <br /> r.P.co. \ / <br />