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FOR OFFICE USE: <br /> ------------------------------------------------------------------- •-� <br /> ------------------------------------------- <br /> - --- <br /> APPLICATION FOR SANITATION PERMIT Permit No. . i.- <br /> (Complete in Duplicate) / <br /> Date Issued <br /> --------------- --- -----------------------mw_--- This Permit Expires 1 Year From Date Issued ,r� m a <br /> Application is hereby made to the San Joaquin Local Health District for a permit to constru tan ll 4e work herein described. <br /> This application is made in compliance with County Ordinance No. 9. I � l <br /> C _ Ie7qo(� <br /> JOB ADDRESS AND LOCATION.... - - — -: ,t< <br /> Owner's Name__-- 6�! Phone Ol --� --�d� <br /> Address--------_------------------0e)6_'11_� . ...... -- - ------ �r� ----•--•------- <br /> Contractor's Name--------- +'�- 'C# �z� Phone <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -_l--- Number of bedrooms Number of baths __ Lot size _. . _. - �f6 ------------------- <br /> Water Supply: Public system ❑ Community system ❑ Privatepth to W er Table -------- ft. <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 �ew Construction: Yes Flo ❑ FHA/VA: Yes �o ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Ta Distance from nearest well-,51_-?-_.....Distance from foundation._,�__e-_i.-------Maternal___._ .444--G --- <br /> No. compartments <br /> � <br /> of com artments--.....—Z---_ -Size__ _ --Li uid de th----- __.---------Capacity- .--? <br /> Disposal F Distance from nears well�__"..- from foundation. __ Distance #o nearest lot line_, , <br /> Number of lines_---,�____ __�___._-f____.____Length of each line_ _ J __ -Width of trench..� __ �---------------� <br /> Type of filter material___1/ '. �Ipth of falter material_... _______.__.Total length-�,Q--_________._.--.---:---wt.nll <br /> Seepage Pit: Distance to nearest well____------------------Distance from foundation_-__-_-.._-_-_-.---.Distance to nearest lot line__----_-__---. <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter_.___.----.......-.---Depth_.-----_---------------------- <br /> Cesspool: 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 /> ❑ Distance to nearest lot line..--- -------------- ----------------------- -------------------------------------------------------------- - ----------------------------- <br /> Remodeling and/or repairing (describe):--------- _#_.U�M1 `�L`}----- ------:'r4- t ---------5- - 'U41------------------------------------------------- <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 t <br /> ordinances, St ws, and rullpand regulations of the San Joaquin Local Health District. <br /> [Signed) 'k `.L'y-. --------------------------------------------(Own rand/ar Con+ractorj <br /> - _ — .— e By:--------------------5�6t. <br /> - ------ �� -- ------ (Title)----Q !`�/V c'`/.------- . .... -------- <br /> (Plot plan, showing sizlocation of system in relation`fio wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY > <br /> APPLICATION ACCEPTED BY----- - ---- DATE C z ---'.F------------------------------- <br /> REVIEWEDBY------------------ --------------------- ---- ----------------------------------- ------------------------------------------- DATE------------ ---------------------------------------------- <br /> BUILDINGPERMIT ISSUED---------------------------------- ------------------------------------------------------------------- DATE---------------------- ---- --------------------------------- <br /> Alterationsand/or recommendations--------------------- ------------------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------------- --- ----------------- ----------- - -- -------------------- -- ------------------------------------------------------------------------------------------------------------- <br /> --------------------- ---------------- .........­----------------------------------------------------------- -------------------------------- ---------------------------------�--J------------------------------------------ <br /> FINAL INSPECTION BY: . n ---------------- Date-- .. .` �f__ ------------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street t 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.p.Co• <br />