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FOR OFFICE USE: <br /> -------------- <br /> �- - C_ -----_ APPLICATION FOR SANITATION PERMIT Permit 'iVc,::------ s� . <br /> ----------- - - /.-L_r��---- (Complete in Duplicate) <br /> -..__._-_.__ This Permit Expires 1 Year From Date Issued 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 /> JOBADDRESS AND LOCATION--,-Z/,2,.---/_ -- ------- -- ----- ---------­-------- -- -------------------------------------------•-•---------------------------------- <br /> Owner's Name-.0—al----11 - - F ------•--------------------------------------.------------------------------------------ Phone-------------•---------------------- <br /> Address__ .. - e- - :: -------=----------------------- ------------------------------------------------------------------------------------------- <br /> i <br /> ------- --- ---- Phone--------------------------------•-- <br /> Contractor's Name � Ur <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ___ ___ Number of bedrooms Z-._ Number of baths -2, Lot size -----?.-_--0---OK-4 ----------------------- <br /> Water Supply: Public system [—Community system ❑ Private ❑ Depth to Water Table i O_ 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 New Construction: Yes ❑ No 2 FHA/VA: Yes ❑ No [?I' <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-_-!p_...........Material __. -._. <br /> No. of compartments------2---------------Size-----c __3E_�.- - --Liquid depth-----�..--------------Capacity---- <br /> t Disposal Field:Field: Distance from nearest well_________________Distance from foundation_./k._-----------Distance to nearest lot line__S___________ <br /> Number of lines-_1----------------------------Length of each -------------- -----Width of trench.------4_4___--_._____--_--- <br /> Type of filter material___-'oG-C----------Depth of filter rnLaterial__/k---------------Total length----- _____--__-_____________._ �1 <br /> 4 4. <br /> Seepage Pif: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_-------------- <br /> ❑ Number of pits------------- -------Lining material-------------..J.--,Size: Diameter-----------------------Depth- --------------------------__--- <br /> Cesspool: Distance from nearest well-----------------Distance4rom foundation------------.-_-_...Lining material------------------------------------- <br /> . <br /> ❑ Sze: Diameter ------Depth- --------------------------------------------------Liquid Capacity------.--------------------gals. <br /> Privy: Distance from nearest well----------------------------------- _________Distance from nearest building-__._..___.------------------------------- <br /> « - M <br /> ❑ Distance to nearest lot line...------- ---------------- --------- ---------------------------- ------------------------------------------------------ ------------ <br /> Remodeling and/or repairing <br /> -- {desc;ribe):------ - . ......�----------- ------- - -----------------•----------- <br /> -------------------------------------------------------- ---•------------------------------------------I---------------------------•--------------------------- - -------- ------ ----------------------------- <br /> H <br /> ' -------•-------------------------- .:. . - - -- -- <br /> ------------ <br /> a. r <br /> --------- hereby -—--- ------------------pp--------•----------------------------------- -- ---•---------------------------------------------------------------- <br /> ordinancStce f'f sh t I have <br /> prepared his application <br /> ation and that the work will be done in accordance with San Joaquin County <br /> the San Joaquin Local Health District. <br /> (Signed) x' R ( - - = ---------------(Owner and/or Contractor) <br /> --•--------------- --------------------------------------------------=-------- ------- <br /> �Y�--- --------- - `-------------------- (Title)-------------------------------------------------- :. <br /> (Plot plan,�s owing size of lot, location of system in relationfo w"ells,'• buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY:- ------- ----------------------------------- DATE------ ------------ ---------------- <br /> REVIEWEDBY = =-------------- ------�-- ----------------------------------------- ---------------------------- DATE <br /> BUILDINGPERMIT ISSUED-------------------------------------------------------------------:----------------------------------- DATE--------------------------- ------------ ---------------- -- <br /> Alterationsand/or recommendations:---------------------------------------------- ---------------•---------------------------------------------------------------•-------------------- <br /> t <br /> r <br /> k <br /> i <br /> _________________________________________________________________________________________________________________________________________________;_.-..______--.____-.___.____-_____--___-.----.-.__-___.-__-.___-.___-_-.__.-_ J <br /> FINAL INSPECTION BY------------------ ----------'-------- Date ._� - �� <br /> --- ---- -------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 1144iiF2b5 West 9th Street <br /> Stockton,CqJifornla�� Lodi,California Manteca,California Tracy,California <br /> F.P.CO. <br /> m.+ J <br />