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rvr< vrri�c uot: <br /> -------------- ---- --------------_- ---- ----------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. l- _ <br /> ---------- ----------- --------------- --------- (Complefe-in Duplicate} <br /> - Date Issued - <br /> ---- --� � -�� <br /> This Permit Ex ires 1 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 /> E _ -_ -JOB ADDRESS AND LOCATION-._ / f / A ---r --- -- ----. --- -----_ _ <br /> c a <br /> Owner's Name A ` e------- «__r----------------------------------------------- -- ------------------------ ------------ <br /> �} <br /> Address- ----- - - - -----------I -` _- JT -----------------------------------------------•----- <br /> 4,-_; U. - Phone- ",,�- <br /> § <br />�i Contractors Name------�-- --`-==- �-��-�---�=-�. � - -- ------- -------------------- - ----�-�------- �•-rt__�`'�'F�_,.- ---• <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: Number of bedrooms -2., Number of baths -1----- Lot size ___--e%� <_ _ ---______________ <br /> Water Supply: Public system ❑ Community system 0 Private Depth to Water Table lVt <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam &. Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date__................. ) No New Construction: Yes ❑ No KFHA/VA: Yes ❑ NoX <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool Permitted if public sewer is available within 200 feet.) r <br /> 3 Septic Tank_ Distance from nearest well-----------------Distance from foundation--------------------Material._-.---___..--.._--_-_-----_------_-----_._---_. - <br /> ❑ -k1'241 No. of compartments------- ---- -------------Size--------------------- -------=---Liquid depth--------- ------- ------- Capacity----------------------- <br /> F <br /> Disposal Field: Distance from nearest well-. --_.__Distance from foundation j A fF f <br /> � ��_`_-______Distance to nearest lot _�_.--_ <br /> Number of lines of each line- .�-- --- ------------Width of trench--- _' '__-_-------_----------- <br /> Typesof filter mate rial__( . f _.___Depth of filter mafer.ial---- -_ ------------- otal fengfh-----; _ :_ ____________________ <br /> Seepage Pit: Distance to nearest well ._ __ ____Distance from foundation--_/ --__ -----Di�tanco to nearest lot line- <br /> - - --,S'Number of pits.'?`f­ka,� Lining material t ' ,,-- Size: Diameter_-. _--_-_Depfh_4�x ------- <br /> Cesspool: <br /> - _Cesspool: Distance from nearest well -________--- -- from foundation---------- ------ ..Lining material--.--_--_--------------------------- <br /> ❑ Size: Diameter. -- ----. ---.--.DePth-_--_- _----.- ------- ---- --- --- - ---.Li�uid Capacity----------------------------gals. <br /> Priv Distance from nearest well--------------------------- .__Distance from nearest building-. <br /> ❑ Distance to nearest lot line ------------------------------------------------------------------------------------------- --- <br /> ----------------------- <br /> `s <br /> - - --- ..--.-------- <br /> ------ ---------------------- <br /> Remoden9 and/or re airirg Idescribe : ..------------------ ---------------- <br /> 11 <br /> ------------ -----� - <br /> - r .J _ - <br /> • <br /> = --- -------------;---------------------------------------------------------------------------------------------------------------------------------------------------- <br /> - --- ----- <br /> E hereby certify�f I have prepared this application and }hat the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, nd rules and regyrations of the San oaquin Local Health District. <br /> { _<:'! 'L �'` a -�,� ----------------- -------(Owner and/or Contractor <br /> (Signed) -------�-�---- �=-. �-'-�'._��--- � �''.��.� - (O ) <br /> ---------- :� ---------- --- - = -- ------------ <br /> Y { (Title)---J. . -.--- ------- ---- -- <br /> h {Plot plan, showing size lot, location of system i relation to wells, buildings, etc., can be play d on reverse side}. <br /> j I <br /> - FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED B - -- ------ DATE_------�-�Z-� <br /> REVIEWED BY--------------------- <br /> ------ -------------- ------------------ ----- ----- -------------------------------------------- DATE----------------------------------------------------------- <br /> BUILDING PERMIT'ISSU -------------------------------------------------------------------------------- DATE <br /> Alterations and/or recommendations--------------- --- <br /> r <br /> --------------------- -------------------------------------------- ---------------- ---- ------------------------------------------------------------------- ---------------------------------------- <br /> ------------------------------------------- -------------------- ------------------------ ------ -- - - - ---- -------- - --- --------------- ---­-­---- --- <br /> - - - - <br /> ---------- <br /> FINAL €NSPECTION ' d - - ------- Date �9^ l=�' 7 - <br /> --------------------- <br /> ! S N JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxellon Ave. 300 West oak Street 124 Sycamore Street 205 West 9th street <br />