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FOR OFFICE USE: <br /> APPLICATION FOR--,SANITATION PERMIT Permit No. ..�- <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 /> t <br /> JOS ADDRESS AND LOCATION.....---.-- ---- ---- -- ------- d�. `.-., <br /> Owner's Name---------- .i-LV_s------ �� ------ Phone------------------------------------- <br /> Address -•• - ------------ <br /> ♦ r t <br /> Contractor's Name-----1.0 <br /> ----------------• Phone CKP--= !_T <br /> ---------- <br /> Installation will serve: Residence'gr"Apartment House ❑ ,Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -_ Number of bedrooms - _.Number of baths.--/ Lot size _.J`w -�Xl � ------------------- <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table�Q_ ft l <br /> Character of soil to a depth of 3-feet- Sand ❑f Gavel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Q( Hardpan ❑ 1 <br /> Previous Application Made: (If yes,date_-----------_---__- ) NoNew Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: , <br /> (No septic tank or cesspool permitted if ublic sewer is available within 280 feet.) <br /> i <br /> Septic Tank: Distance from nearest well4 �__ <br /> Dis#ancefrom foundation-/4_._____-.Mat ial --------- - -_---_- <br /> I - ",/ <br /> No. of compartments._._— ........... Liquid de th.. 4Capacity./OW. <br /> I �'A . / <br /> Disposal Field: Distance'from nearest well_ Distance from foundation.-fa------....Distance to nearest lot <br /> Number of lines_..._____ � Length of each line________...-----___Y Width of trench.-- --------------------- <br /> � �, <br /> 27, <br /> Type of filter ma#eriaL -!!C�±: __Depth of filter material__le._ .-____.._Tota! length___.___._._____- _--___--__.--_. V . <br /> Seepage Pit: Distance to nearest well Distance from foundation-_- �_�-.---.Distance to nearest lot I'sne_.5`___._____ <br /> Z------------- <br /> �. Number of pits--. -/--------------Lining rnaferial- ..... Siie: Diameter__��_�� -.Depth-------,a-Z-�.'---- ---• 1 <br /> A <br /> Cesspool: Distance from nearest well ----------------Distance from foundation----------------- - Lining material-------------------------------------- <br /> Size: <br /> .._.._-----___._--. _.Size: Diameter- -- --------- ----- ---------------Depth------ --- - ------------ --- ........Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-----______----____------------------------------Distance from nearest building__._--__...-,------.--------_-.-----___--- <br /> ❑ Distance to nearest lot line -----------:- - ----------- ----- -------------------------•---•-------------------------------------- <br /> Remodeling and/or ?repairing (describe):--.' - .I-CG-------------------------------------------------------- <br /> 1 - - <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 an regulations of the S n Joaquin Local Health District. <br /> Si ned .(Ownpr and/or Contractor <br /> ( g ) - ) <br /> BY:---------------------------------------------- ---- --- - ---------------- --------(Title) <br /> (Plot plan, showing size of lot, location of system in relation to ells, buildings, etc., can be pi ed on reverse side). <br /> r <br /> FOR DEPARTMENT USE ONLY <br /> 550o <br /> APPLICATION ACCEPTED BY- <br /> -- -"`--k..---------V------ ---------- --- - ------------------------- ----"--------- DATE_..' 2 ----------------------- <br /> REVIEWEDBY----------I--------------------------- ------------- - - ------- ----------- ---------------------------------------------- DATE-------- <br /> BUILDINGPERMIT ISSUED-------- -- ----------------------------- --------------------------- ------------- ---------------- DATE----------- ----------------------- ------- <br /> Alterations and/or recommendations:---. <br /> ---------------------------•--------.------- -------- --- -----Q. : - ----0-:::::: :C: :: :I-----w_. : :___::------:------:_:::_--------:-:------I::---------------------------- <br /> I <br /> r-ft <br /> - -- ---- ---- ---- -- --------.......... -------------- --- ----------------------- ------------------------------- - ------------ - -- -------- -- --------- ----------------- ------------------------------------- <br /> F1NAL INSPECTION --- --- <br /> BY, --- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Slockton,California Lodi. California ' Manteca, California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press . k F <br />