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FOR OFFICE USE: <br /> ---------------------------------------- <br /> -----------------_________________________.._.-__-____. APPLICATION FOR SANITATION PERMIT permit No. .__-----_�i.?`_"--- <br /> -- ------ -------- (Complete in Duplicate] <br /> � Date Issued __aoz_..__�.^-S.J <br /> ------------------------------------------------------ --- This Permit Expires 1 Year From Date Issued <br /> r <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 complian e with ounty Ordinance No. S44. Tlr.W_ <br /> �f-S 1 T1 c��✓_- ti° N�'� 1►' ----------------- <br /> -- ��?Q <br /> JOB.ADDRESS'A 'LOCATION_.________ l <br /> Owner's Name------------��'��----- �_ ,E <br /> ------------------------------- - ------- .` -- --Address---------------_----- /---- __3---------f -� -----' <br /> Contractors Name / t1 ��------------------------------------------------------------------------- Phone__-,it04/5_-� -7 <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial railer Court ❑ Motel ❑ Other ❑ <br /> I Number of livingunits: ---0.- Number of bedrooms,_ <br /> _ f)__ Number of baths __,7._ Lot size ____�9�'2/�_`_�_��___________-_____ <br /> Water Supply: Public system ❑ Community system ❑ Private q;-­0epth to Water Table 4�P_ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 2-"C-lay Loam ❑ Clay ❑ Adobe E] Hardpan ❑ <br /> Previous Application Made: (If yes,dote---------------......} No EP"' New Construction: Yes ❑ No FHA/VA: Yes ❑ No Ea-' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br />` -ter-(No,sepflc.,.fankTor_cesspool-permitfed;.ifYpublic.sewerAs-available-within_200•.feet:) <br /> Septic Tank: Distance from nearest well_________________Distance from foundation-- ----------------Material------------------------------------------------- <br /> No,/of <br /> -----..---_._.____________.____---.---______- <br /> No/of compartments--------------------------Size--------------------------------Liquid depth--------------------- ----Capacity-------------- -------- <br />'l <br /> Disposal Field: Distance from nearest well.................Distance from foundation--------------------Distance to nearest lot line___________._____ <br /> ❑ Number ofiine',s-1---------------------------------Length of each line------------------------------Width of trench----------------------------------- <br /> r. <br /> Type of filter material-------------------------Depth of filter mai-erial------------------------Total length-----------_---_-------------------------- ...� <br /> Seepage Pit: Distance to nearest well---AM/7T-Distance fr m foundatio ._ -__ 7� <br /> �� ... <br /> [� Number of pits--------- ----------Lining material_ /i��'�(�_.Size:n .___.Distance to nearest lot <br /> Diameter:rini)ng <br /> --.-.---Depth _____-.._..___/QCesspool: Distance from nearest well_________________Distance from foundation--------_-.- /40 <br /> Cesspool: <br /> ❑ s�rm Size: Diameter---i----------------------------------Depth-------------------- --------- ;r.= Liquid Capacity----------------------- gals. <br /> Privy: Distance from nearest well: ;-----------=--__-___------___-------------Distance from g - <br /> nearest building--------- <br /> ❑ Distance to nearest'lot line --------------------------------------------------------------------------------------------------- ---- ----------- - <br /> Remodeling and/or repairing '(clescribe�:_...___ �_ r <br /> I <br /> ---------------•----------•---------------------------------- --------------_---------------------------------------------- -- <br /> I - ------ <br /> ---------------------------------------=------------r--------- - ------------------ , <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------=---------------- <br /> I hereby certify that I have prepared this application and that the-work will be done in accordance with San Joaquin County 6 <br /> ordinances, Sfafe la rules and regulations of the San Joaquin Local Health District. <br /> I --...____- wn and/or Contractor <br /> (Signed}------------------- -' ��L�-L� - � .�i��..----------------------------------------------------- - � / ) <br /> BY: ----------------------=--------------------------- --------(Title} r----- --- <br /> F;,;� (Flo# plan_,sllowing,si e;off locatio}o# systernms .i lation to wells building,�etc.,, an,be placed an reverse side]. <br /> tr IFOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--_.�_ _ -`--------------------- 7 !T <br /> DATE_.---- <br /> REVIEWED BY_--'------------- ----- ' -------- <br /> ------- DATE <br /> BUILDINGPERMIT ISSUED---------------=-------------------------------------------------------------------------------------- DATE----------------------------------------------------------- <br /> Alterations and/or recommendafions:- < <br /> - - •-- ----- <br />{ /VDf�-------CNAI�C�.�----"-1Al-------5'/��---O►`-•---- '� ----------��-—-- --L-/� 1 <br /> -•--------------------------------- - <br /> I -F- Q <br /> -:.---------------------- = ---------- <br /> --- -------- -------------------------- ------ --------------------------------- <br /> ----------------------- <br /> -------------- --------------------------------------------------- -- <br /> FINAL INSPECTION- 2 _ ...___ _. <br /> Date---------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Slocklon,California Lodi,California Manteca,California Tracy,California <br /> F.P.CO. r <br />