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FOR OFFICE USE: Tq <br /> ------ -------------- ------------- <br /> tr Permit No, • 7 <br /> -- --- --­----------------- APPLICATION FOR SANITATFION PERMIT <br /> -------V, I <br /> ----------------------------- - ---------------- (Complete in Duplicate) Date Issued <br /> -------------- -- ­----------------------- This Permit Expires I Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install Xe-worl herel 1 describe) <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION_ <br /> Owner's Name----- <br /> ---------W ---------------------------------------------------------------------- ---------------.__ Phone------------------- ----------- <br /> Address- Salo- -------------------------------------------------------------------------------------------------------------------------------------I--------------------------------------- <br /> Confractor's Name---------/Pr Vl-,,------------------------------- ------------------------------- ------------ Phone-----.------------- .......I------ <br /> Installation will serve: Residence t;, Apartment House [] Commercial [:] Trailer Court ❑ Motel El Other 0 <br /> 'do ----------------------------- <br /> Number of living units: Number of bedrooms _J__ Number of baths -99---- Lot.-size _4? <br /> Water Supply. Public system ❑ Community system E] Private k"'Depth to Water Table - ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam E] Clay E] Adobe 210TH"ardpan E] <br /> Previous Application Made: (If yes,date--------------------) No �New Construction: Yes E] ' No [emsFHA/VA: Yes [] No [f�— <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> 1 14 -N I <br /> Septic.Tank: Distance from nearest well-4-______________Distance from foundation____-__-______.__.- Material_________.-.__.__----------------------------- <br /> OF No. of compartment _Siz�--------------------- ----------Liquid depjh-------------- - ---------Capacity---------- <br /> ------------- ---- --- ------------- <br /> Disposal Field:- Distance from nearesf`weII__/S�0._Disfance from foundation,?P----------Distance to nearest lot <br /> 5'17,W%� Number of lines <br /> _________f <br /> .e maferia)4 <br /> - ----------------------------- <br /> - -----------------/_ I en fh f each line--- Width of trench. <br /> 4 * � , g o <br /> Ty .,of�filter �'Aepth of filter'material�� ------------------Total length_--IY49- ------------------------ <br /> Seepage Pit- N/Disfan�c .1 01 .0, <br /> e�fo nearest Distance from foundation-_-346F------Pista��e to nearest lot Iinp­11e7Z9 <br /> aferial___,4&4Z;-e Size: Diameter-_%?3_1..-___Depth- <br /> ,,..-Number—of pits'-"':--____-__Lining m <br /> A\] <br /> Cesspool: Distance from nearest well--------------I—Distance from foundation------ -------------Lining material___---------__-____-______.--_______ <br /> El Size: D;arneter---------------------------------.--I,.Depfh---------- ---------------------------- ------------Liquid Capacity----------------------------gals. li <br /> Privy: rDistance from nearest well-------------------- ------------------------ --____--_Distance from nearest building -------. <br /> Distance to nearest lot lire- ------------------ <br /> Remodeling�and/cr irepairing (describe):-. ------------ -------- ---------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------- ------- -------- - --------------------------------- ------------------ <br /> --------- ------- ... <br /> -------------------------------- ------------------------------------ -------------------------- ------------------------------------I------------------------------------- ----------------------------------------­ <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 a d regulations of the San Joaquin Local Health District. <br /> --------------------------- - - -- - -------- <br /> (Signed) -- -- -- --- ------------ ---------- --- -------------------------------- ---(ennMallmadjor Contractor) II <br /> By:--------------------`------------------------------------------- - ------- ------------- ----- r------ <br /> (Plot plan, showing size of lot, location of system in r tion to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_________________ 11-17-01- ------------ -- --------------------------------------- DATE ' <br /> ---------------- <br /> REVIEWED BY----- -- <br /> ------------------------------------------------ --- ------------------------------------------------------------------ DATE----------- ------- <br /> BUILDING PERMIT ISSUED--------------------- <br /> DATE---------------- ----------------- --------------------------- <br /> ----- - <br /> Alterations and/or recommendations.- <br /> ------------------------------------------------------------------------------ <br /> ------------- ------------------------------------------------------ ------------------------- ----------------------------- <br /> -------------------------------------- <br /> ----------------------------------------------------- <br /> ---------------------­---------- -------- ------------------------------ ----------------------------- ------------------------------------------------------------------------------------- ----------------------------- <br /> ------------------------ ------------------------------------------------------------------------------------------------------------------------­---------------------------------- - ---- -------- ----------------- <br /> ------------------------------------------ <br /> ---------------- <br /> ----- -- - ---- - ---------------------- -------- - ­------------------------- -----------­­------ ------- - ------------------------------------------------ <br /> FINAL INSPECTION BY:...... <br /> ------------------------- -------------- Date-- - --------% ---- ----- ............ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hatelifore Ave. 300 West Oak Street 124 Sycam ore Street, 205"West 9th Street <br /> Stockton,California Lodi,California Manteca,California" Tracy,California <br /> A <br />