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FOR OFFICE USE: <br /> -----------j-%-,3--u--------- ---------------------------- - [ .._---.. APPLICATION AOR SANITATION PERMIT Permit No. <br /> ---- -- ----- (Complete-in Duplicate) <br /> - --------------- ---- ___ This Permit.Expires 1 Year From Date Issued_ <br /> 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 Ordinance No. 549. ' <br /> JOB ADDRESS AN LO TI g } CU ......... � ----------•-----------•-- <br /> Owner's Name--------- -s..Ct_ ------ ------------------- ------ ----------------------------------------------- Phona��-7 -All <br /> Address-------------------- -- - •-- <br /> -- <br /> Contractor's N� - (' <br /> • i �-----•--- Phone.. -67 <br /> Installation will serve: Residence partm t use ❑ Com ercial ❑ Trail r Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __�__. Nu r-of bedrooms7,----Number of baths _.._ Lot size --- <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 155bft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeardpan ❑ <br /> Previous.Application Made: (If yes,date................... ) No ❑ New Construction: Yes ❑ N*4HA/VA: Yes F1 No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> o septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> S Ta Distance from nearest well-----------------Distance from foundation--------------------Material ----.-----------------------------------...__._- Q <br /> o. of compartments--- --------- ize-------------------------------Liquid depth--------- ------- --- Capacity---------------------- <br /> Distance from nearest well.. istance from foundation_../0_'7__..Distance to nearest lot line-------- ..... <br /> Number of lines ---- Length of each line_ ._�" - Width of trench._ f(_____ _ _____ <br /> pd 4� <br /> Type of filter materia -----Depth of filter material---- ..' .__Total length_______________________�U <br /> S Pit: Distance to nearest we0--0. _ __ _____Disfance rom foundation-- _.-_.Distance to nearest lot line-451* <br /> Number of pits...1-----------------Lining material__ __ _ . __._.__ Size: Diameter_��U/I-___--Deptn_ZS,�111` <br /> Distance from nearest well ----------------Distance from oundation-----------------..Lining material__....._._._-____._.___.____________ <br /> ❑ Size: Diameter- -- - ------- ----- ----------------De th--------- - --------- - - -- - -._Liquid Capacity... ----- - - ---------gals <br /> . ^ <br /> h` <br /> Privy: Distance from nearest well------__--------____---___---------- __________Distance from nearest building_._.__..__._______-----__._-__.__..__..._. V <br /> ❑ Distance to nearest lot line --------------------------------- ----------------------------------- <br /> Remodeling and/or repairing (describe):-------- ------------- ----- - - -------- -------------------------•---•------ <br /> -------•---------------------------•------------------ --------------------- --------------- -- ---- -------------- ------ AX, ------- ------------- ---- <br /> ----------•--------------------------------- -------------------------------------------- t <br /> I hereby certify tha I hay prepared this application and tat the work will be done in accordance with San Joaquin County <br /> ordina;es, Stat s, es and re lotions of 4 n J quin Local alth Distq-- %� r' t. <br /> (Signe -- --- ---------- ---- -- ----- !` `�------------. ---( cVor Contractor) <br /> By=------------ -------------- -------------------------------------------------------- - --- ----- (Title)----------------- -- --- - -- ------------- ............­ <br /> (Plot plan, showing size of lof, location of system in relation to ells, buildings, a ., can be placed on reverse side). <br /> F D ARTMENT USE ONLY y <br /> APPLICATION ACCEPTED $Y- - -------------- <br /> 757 <br /> ------------ <br /> ---------------- <br /> REVIEWED BY----- -------------------------------A-��l-- ---- ------...--- -------- ----------------------------- DATE-------BUILDING PERMIT ISSUED-------- -- ---------- ------------- -------- ....... ------•-------------------------------------.- DATE----------------------------- ------------------------------ <br /> Alterations and/or recommendations----------- ----- -- - ---------------------- ---------------------------- ------------------- ------------------ --------•---------------------- <br /> - ------------------- ----------------------------------------- ------- - .......---------------------- -----------------------------•------- ----- •--------------- <br /> -----------------------------------------------------•------------ ----- - ---------------------- --------------------------•----------------------------------•----- ----•---- --------- <br /> ----------------- -------------------------------------- ---------------- -- ------------------------------------------------------------- - ­­- ---------------------- -------- --- ----------- ---------------- <br /> ­--- ------------------------- ---------------------- -- - --- --- -------------------------- -- ----• - --------- ---------------- <br /> FINAL INSPECTION BY:. .. ��--.`- �­--------------- Date.... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1401 E.Ha:elion Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,Callfornia Lodi California Manteca,California Tracy, California <br /> E.H.9 2M 1-67 Vanguard Press <br />