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FOR OFFICE USE; S, <br /> - -- ------------ ------ ---------- ----------- - <br /> APPLICATION FOR SAN1fATION PERMIT Permit No. _ �1 <br /> - ------------------- --- -----. -_ (Complete-in Duplicate) <br /> _ __.-____________________ This Permit Expires 1 Year From Date Issued Date Issued <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 Or inance No. 549. <br /> T <br /> ------------------ <br /> JOB ADDRESS AN CTN._ ------ __ - - _ . . . a- - Phone----- _ _ C_Owner's Name <br /> Address------------- -11-0-.1 � hk�. �-------- ---------- .....-• ----------•--.--. --- <br /> Contractor's Name-------- -�.� ---------------- Phone------ ----------------_---------- <br /> Installation <br /> .--.------ .-Installation will serve: Residence Apartment House ❑ r'Commercial .❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _. ._-- Number of bedrooms -.2,_-- Number of baths/------- Lot size "--------------------- <br /> Water Supply: Public system ❑ Community system ❑ .Private [;g�epth to Water Table j,4) ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan (3' <br /> Previous Application Made: (If yes,date........... ] No I' New Construction: Yes ❑ No e FHA/VA; Yes ❑ No E_j(W <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ' <br /> (No leptic tank or cesspool permitted if public sewer is available within 204 feet.) <br /> Septic ank' Distance from nearest well.................Distance from foundation--------------------Material ------------------_--------_._____----------.._. <br /> 'No. of compartments------------ - Size------------- ------ -----------Liquid depth.-------- ------- --------Capacity------------------- �l <br /> r r —/ <br /> Disposal 'el-. Distance from nearest well..ro._ ....Distance from foundation--------------------Distance to nearest lot line__1 _______ <br /> Number of lines____ _-----------------------------Len th of each line-_ � __-..Width of trench._ _. .____._--____-._____ <br /> ❑ ! g <br /> Type of filter materlal__J iX_,--------Depth of filter ....... ..Total r length---::`/SS___---------._r_-___-----_- <br /> Seepage.Pit: Distance to nearest well-.,/4947-_.--------Distance from foundation__/!..............Distance to nearest lot line_s7f <br /> F_.______ <br /> []� Number of pits.__ ----------- ---Lining materialfj_&L.j.(------ Size: Diameter.-.--"-.--..-Depth-.------e�ru---------------- <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 <br /> -__---- .-----_____.-.._.--- + <br /> �] Distance to nearest lot line -------- :---------------------------------------------------------------------------------------------------------------- -------------- <br /> i <br /> Remodelingand/or repairing (describe):----- - --------- -------------------------------------•------------------ --------------------------------------------•-------------------------------- <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 r <br /> ordinances, State laws, and r;/_e7 <br /> egulations of the Sa oaquin Local Health District. <br /> Owner and/or Contractor <br /> (Signed)-------------------- ( ) <br /> By:--------------------------------------------- --------------------- -------------------- ------ ---------------------- (Title)--------------- ------.....----------- - ------- --------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---.f-e --- ------------------------- -------------- DATE.-.;Z---^... ---_---------------- <br /> REVIEWEDBY---------------------------------------------- ---- --- --------------------- ------------------ ----------------------- - ... DATE---- --- --------------------------•----------------------- <br /> BUILDINGPERMIT ISSUED-------- ------------------------- ---------------------- -------- ---------------------------------- DATE------------------------------- --.--------------- <br /> Alterationsand/or recommendations------------------ -------- ----- - - -------------------------------------------------------- - -------------------------------------- ---------------- <br /> ----------- ----- ---------- --- --------- ............... ----- - - - --------------------- -- ---------------- •------------------ - - - f------------- ------------------------ ----- <br /> FINAL INSPECTION. {BY:- ...... ...... .,7-, -� Date------9 ---------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <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.92M 1-67 Vanguard Press <br />