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FOR OFFICE USE: <br /> L' <br /> ................ .... _...._ - APPLICATION FOR SANITATION PERMIT Permit No. _-_ t,�...7_..... <br /> � ----`-'-� -- -- ----�--'--3---- (Complete in Duplicate) �� `� � <br />-------------------------------------------------------- This Permit Expires 1 Year From Date Issued <br /> Date Issued l-._....--__-l <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 AND LOCATION-------- •` - .r -----------•;S /Jl/c...................... <br /> Owner's Name......s�_x' b747RRJ.L- _ <br /> Address--••----•.....�•2 /:7— _T4V�i/S'�T 0� off-t................ <br /> Contractor's Name--------'2-'e-= rV.&12-.-----0.!—, Phone./`��'�: <br /> Installation will serve: Residence &r Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: .__. Number of bedrooms Number of baths ----t. Lot size ____.. _ ...« <br /> Water Supply: Public system ® Community system ❑ Private ❑ Depth to Water Table ........ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe®' Hardpan ❑ <br /> Previous Application Made: {lf yes,date--------------------) No 10 New Construction: Yes ❑ No;E1_FHA/VA: Yes ❑ Noy, <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 /> ❑ No. of compartments--------------------------Size--------------------------------Liquid depth------- ------------------Capacity....................... <br /> Disposal Field: Disfance'feom nearest well_________________Distance from foundation--------------------Distance to nearest lot line----------------- <br /> ❑ ��'L Number of lines____._______ `_f___________ _Length of each line_____________________________Width of trench--------------------------------- <br /> Type of filter material_________________________Depth of filter material...........------------Total length.......................................... <br /> Seepage Pit: Distance to nearest well----/49-V--__.____Distan, fro oun tion___..4P....__..Distance to nearest lot line-----1...__.. <br /> T' Number of pits--------/------------Lining mate ral___,lOKize: Diameter.__.__: __''._____,Depth--------- '_____________ } <br /> Cesspool: Distance from nearest well_________________Dis�ote_#r-om—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 /> . I <br /> Remodeling and/or repairing (describe):-------------------------------------------------------------------------------------------C�----...-------= ........................... <br /> --•----------------•---------------------•------------------------•-------•-•--------• ---------------- ---------- -•-----.- -------------------­-----•---------------•---- --------------•------•- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)----- -----0a.._-C--f---------------------- --------------------------------------(Owner and/or Contractor) <br /> i (rifle)--_ -- ------ � _. <br /> BY;............... ( ) <br /> (Plot plan, showing size of lot, location Jf stem in relation to wells, buildings, etc., can be placed on reverse side). <br /> OR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY DATE.... `� -��► !" <br /> REVIEWEDBY.............................. ----------- -----------------' ---' --- •-=-------------•-•-•-•-• - ........... DATE-------------------------------------------................ <br /> BUILDING PERMIT ISSUED ---- ==-------------------•----•--•----- DATE ---------------------------------------, <br /> Alterations and/or recommence ions:S-.z..3:-AR-Z---------l-s'�'._.tW=.... z _ - ------- - --- -1a_____•_..._.....---- <br /> / � . <br /> 'z. _._:.�------ ------------------------------------------------------------------------ f::............... <br /> i , <br /> ---•---•----------•---------------------•------------•---------------•------- ------------------- ----•-- -----------•-------------------•-----------•-----------------------•-•---------------------•._-....•--•--.......... <br /> r e: <br /> --•------•---------•---------•--•---•-----------------••----•-------•------•--------•--•----------------------------------•---------------•--------•-•---..-._-----•---_...,-------.-...._--------------------------------- <br /> ----------- ............ <br /> -------•------------------••-----•---------------------- ------ -----------------------------------------------=------------------------------•-----------•----------•------•-------------------------------------------------------•--•-----... <br /> FINAL INSPECTION BY:---- ------��--------- ---•---------------- Date.... te.-z 3.-. -..-..--- -•--- --•--••---•------•------•---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ,4 <br /> 130 South American Street 300 West Oak Street a 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REvtSEO 8-99 2M 8-61 ATLAS <br />