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I 4 I VIS lJi 1 IL.L V.]L: <br /> -------- - ----- - APPLICATION FOR SANITATION PERMIT Permit No. � 2�__---:- <br /> ------- -- - <br /> --------- -----._ ._..--------- _ - _ --------- (Complete in.,Duphcafe]; <br /> Date Issued._,�7'����� <br /> ._ .__ This Permit Exp rds T Year From Date Issued <br /> Application is hereby made to the San Joaquin;L,6tai Health District for a permit to construct and install the work herein destrbed. <br /> This application is made in compliance with C&nty Ordinance No. 549. <br /> -11 <br /> [m r r <br /> JOB ADDRESS AND O 1ON 1 _ r�" - � -------------- <br /> ---------- <br /> -- ----- <br /> � .rte --- - --- -- <br /> �� -.---------------- � ----------------------. Phone-9--36== 2a_L_'": k <br /> Owner's Name- _-.- -- - ----. __-- _ <br /> -------- ---------------------- <br /> ----------- <br /> 0-21 <br /> Address__ <br /> F,F, Contractor's Name_ .-!/� � % l < ------- ------- ------------------------------ ---------------- <br /> ------------------------------ <br /> Installation will serve: Residence F] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> i Number of living units: --1_-___ Number of bedrooms __ _ Number of baths____4__ Lot size __ e'` ______ ___________-___._____._ <br /> r-, <br /> _ Water Supply: Public system ❑ Community system ❑ Private �0 Depth to Water Table W ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam kr Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: Ilf yes,date-_...- --;------- I No ® New Construction: Yes ❑ No [a FNA/VA: Yes ❑ ' No � <br /> z TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> F� F 7 <br /> Septic Tank: Distance from nearest ------Distance from foundation__./4Z_--------Matenal._ ------------------- <br /> No. <br /> _________________No. of compartments------;�--------- ---Size----- 0,Q------------__Liquid `. __.___..Ca acitY--16L) -_------ <br /> /0_`-_---.--Distance to nearest lot line__WDisposal Fiel : Distance from nearest well -a� Distance from foundation <br /> F <br /> Number of lines.---------- - ---------------Length of each line_- ..._ �` Width of trench.--- -`�-y______________------ <br />} Type of filter material_-_ 6(`�._-__Depth of filter material____/_�`r_________Total length______»:__------------ <br /> Seepage Ni: Distance to nearest well----------------------Distance from foundation---------------.___Distance to nearest tot line____:_________.__ <br /> ❑ Number of pits.--------------------Lining material----------- Size: Diameter-----------------------Depth-'-'-'.__'s--------------- <br /> Cesspool: Distance from nearest well ________________Distance from foundation_--_.._-._._-__ . - <br /> Linin material_.______ �-________ <br /> l ] Size: Diameter -- -------------- ----------------Depth--------------------- -----------------------------L'quid Capacity---------=------------------gals. <br /> Privy: Distance from nearest well-----------------------------------------------_Distance from nearest building_--____-__.----------_ <br /> ❑ Distance to nearest lot line ----------- ------------------------------------------------------------------------------------------------- <br /> l Remodeling and/or repairing (describe':---9 r /1 _ ____ ______ ` <br /> ----------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------- <br /> �-�• <br /> • Y ______.___.-----------------_---------------------_------------------------------______._________________----___________-_______-_______-_._-_------___-______.___-_________.________________._._____________-----..___- �-q_ <br /> I here6y certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun 1,_1 <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> �f r <br /> F (S1 ned _ __________ ______ _________� -�_�------------_ __.(Owner and/or Contractor] <br /> 9 } --------------------------- ---------------------- <br /> -----------------------{Title}-- <br /> - <br /> �{ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can 6e placed on reverse side). iC <br /> �.. FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED B = -- ---------- ------------------------------- ---------------------------------------- DATE ------���-g- �- <br /> rREVIEWED BY---------------- --- ------- ----------=-='---------------------------------------------•------------------------------- DATE:-------------- -------------------------------------------- <br /> BUILDINGPERMIT ISSUE . ------ - ------- --- ------------------------------------------------------------------- DATE---------------------- <br /> Alterationsand/or recon mendafions::------------------------- ----------------- - --------------------------------------------------------------------------------------------------------- <br /> 1 - -------- -------------- ------------------------------------------ ------------------------------------------------------------------------------------ <br /> µ ------ <br /> ------------ ----------------------------------------- <br /> ------------------------------ -- ------------------ ---------------------------------- ------------------------------- ------------------------------------------------------------ -------------------------------- <br /> x -------------------------------------------------- --------------- <br /> ---------- ------------- ----------- ---- ---------------------------- ------------------------ - --------------------------------- <br /> FINAL lNSPEC71 BY: - Date- - ----------�- ------ - - -------------------------- <br /> a 4 5:4 JO UlN LOCAL HEALTH DISTRICT <br /> 1 601 E.Hazellon Avg. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street <br />