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R OFFICE OiY5' <br /> ---------- --------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No- ----------- ........... <br /> 4 I l7 (Complete in Duplicate) <br /> _ Zf#X - Date issued <br /> -------- -- This Permit Expires I Year From 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 AND LOCATION----------- ------------------ --------- ----------I------------------------ <br /> ------------ <br /> L' Cl 4;Lq Khone-_ <br /> Owner's,Name-------------- ---------------- - --------------------------------- ----- _77-i-T-3------------- <br /> --- --------- ----------- ---- <br /> Address--------------------------I ...W-1-------------- --------------------------------------------- ----------------_ <br /> Contractor's Name-------------- --------- —------------------------------- -------------------------------------------- <br /> Installation will serve: Residence � Apartment House 0 Commercial E] Trailer Court [] Motel El Other E] <br /> Number of living units: -------- Nu'mber of bedrooms -0--- Number of baths _I..____ Lot size --------- ------ ---------------- <br /> Water Supply: Public system [] Community system El Private Z, Depth to Water Table ft. <br /> Character of soil to a depth of 3 feet:' Sand ❑ Gravel Ej Sandy Loam [I Clay Loam X Clay 0 Adobe E] Hardpan El <br /> Previous Application Made: (If yes,date--------------------) No rd New Construction: Yes E] No FHA/VA: Yes ❑ No <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 /> F-1 I No. of compartments------- ---- ---------..Size--------------------------------Liquid depth----------- ---- ----Capacity----------------------- <br /> I Field: V1 I <br /> Dis Distance from nearest w'ell- 100--I.Distance from foundatic�n_,---1:---- - --Didance to nearest lot <br /> _tL'0 of trenc�.----------:�41 <br /> --- - --------------- <br /> Number of lines---- --- -- _-_�Lengfh of each line ---- <br /> Type of filter material-_ C�K�Yepfh of filter material-.--_ -_Total length___.-57 -13-6_______________- <br /> Seepage Pit: Distance to nearest well---------------------Disfante from foundation-------------------Distance to nearest lot line----_...__..__-__ <br /> --------- <br /> Number of its-------- -------------Linin material----- --:Size:-Diameter-----------------------Depth...--- --------:----_--------------- <br /> Cesspool; Distance from nearest well-----------------Distance from foundation--_._..-- ..... Lining material- ----------________--_-- ------------ <br /> ElSize: Diameter------------------ --- ---------------Depth------------------------------------ - -------------Li uid Capacity------------------------:,._,a1,. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------j---------- <br /> FTDistance to nearest lot line---------------- - ---------------------------r----------------------- ---------------------------------- -------------- ---- -------------- <br /> Remodeling and/or repairing (describe - <br /> ' ------- ------------ 0------- ------------ ------------------------------i----------- <br /> -----------------------------------------------------------------------------------------------------------------------------------------------------------------------r- --------------------------------------------------- > <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------I---------------------------------------------------------------- <br /> ------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Couni� <br /> ordinances. State laws; and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)------------------- ------- -_i <br /> H----------- -------------------------_---------------------- (0 ner and/or Contractor) <br /> ------e-N-- - <br /> By:------------------------------------ -- ------------ ----------------------------------------------------------- <br /> ---(Title) ------------------- ........ ... <br /> (Plot plan, showing size ofi 14,-lo'cation of system in relation to wells, buildings, etc., can be place on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> ------- ------- ------------------------- <br /> APPLICATION ACCEPTED -------- --------------- --------------- DATE---------- --- --------------------- <br /> REVIEWEDBY------------------------- - ----------------------- ----------------------------- ----- ---------- ------------------------- DATE------------------------------------------------------------ <br /> BUILDING PERMIT ISSUED-------------------- ----------- - -------,i----- 6 >------------ <br /> -----------</-------------�-------- -D--A---T--E-----------------------------------------­---­------------------------------------------------------------------------ <br /> - <br /> Alterations and/or recommendafions:----- --- -� ------ 4-e--- - ,A ek -------H ----- <br /> ----------------------- ---------------------------------- -- ------------------------------- ----------------------------------------------------------------------------------------------------------------------- <br /> -------------------- -------------------- ---------------------- ----------------------------------------------------------------------------------------------------------------------------------------- <br /> �01 <br /> ----------------- -------------------------------- -------- ------------ ------------------------- ------------------------------------------------------- - --------------------------- -- - ----- -------------------------- <br /> ------------------------------ -------------------- - ---------------------- ----------------------------I--------------------------- ------------------------ <br /> FINAL INSPECTION BY: ---------- <br /> --- ------------ - ------ ----- ------------ <br /> . .� <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 NianteCOr California Tracy, California <br />