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FOR OFFICE USS: <br /> ---------- a. ` <br /> APPLICATION FOR SANITATION PERMIT Permit No. ..f�. :_-.`._ <br /> to <br /> -------- (Complete-in Duplicate) Date Issued <br /> Q This Permit Ex ires 1 Year From Date Issued <br /> ��� ,�. --------.-...- <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 LOCzT v ,Q J-------- X` f ---------------------------------------- <br /> Owner's Name.-.- -----� ----... Phon - s <br /> Address------------------- T-9G` `t9/ <br /> Contractor's Name---- I --------------------------- ------------ Phone------ ---------•--- <br /> S� <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motpl ❑ Other j%W <br /> Number of living units- _- ----- Number of bedrooms -------- Number of baths--...... Lot size 71--raX.1 1.......................... <br /> Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water`Table,7S-7 ft- <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ 4Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous'Application Made: Ilf yes,date----------......... 1 '•No %` New Construction: Yes ❑ NoFHA/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 /> Septic Tank: Distance from nearest well.................Distance-from foundation----.------------_ Material ------------------------------------------------ <br /> 06K IS <br /> ...--.--_....---..-_----..-.---.-.--------_.❑6C[S7' No. of compartments---------------------------Size---------------- - - ---- ------Liquid depth--------- ------- --------Capacity------ ------------ <br /> Disposal Field: Distance from nearest well./ IJ67-Distance from foundation--- V..........Distance to nearest lot line--- <br /> :5t .�... <br /> Number of lines....Cj_ .. ...-..- Length of each line-- -,�.�r -...�.._..... Width of trench t------------------------ <br /> Type of filter material._. Depth of filter material-. l- ....Total length----.25-------------- <br /> -- <br /> Seepage Pit: Distance to nearest.`welI_1J6V_C:7------Distanc frons oundation__1�..__..--- Dist`r?ce to nearest lot line......... <br /> Number of its.. -f- .Lining material. ..... Size- Diameter p <br /> p De th_- \ <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):------. -Y------------ ---- -- .: .. <br /> - ­---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------r----- ----- <br /> --------------- <br /> ---------------------------------------- ----------------------------------------------------------------------------------------- ---------- ---------------------------------------------------------------------------------- <br /> 1 I hereby certify tha ave prepared this ap lication and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, nd ules and regulatio of the San Joaquin cal Health District. <br /> y <br /> (Signed)--------•------------- --- -- ------ --- -------------•----------- -- ------------ ---(Owner and/or Contractor) <br /> i c <br /> BY: -- - - -- ------ ---- - - ------------------------------{Tule) <br /> (Plot plan, showing size of lot, location of sys em in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY- '- ------------�.-.. - - DATE � --- &-------------------------- i <br /> REVIEWEDBY------------------------------------ ----------------------------- ---------------------------------------- ----------- DATE ----------------------------- <br /> BUILDING PERMIT ISSUED-------- - ---- ----- :D TE-------- --- <br /> NQAlter tions ado ecommendations: - ---------- -------- -•- A— '���- - <br /> �'',",� <br /> _1Vk4A,&AA---/, <br /> FINAL INSPECTION BY:.---_±`_y_e,. kv&------------------ ----------- Date..-/,r-�-.� 9- <br /> ............ <br /> - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> F <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi. California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br /> t _ � <br />