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ON FOR SANITATION 1 t No. ./_�{.__- b <br /> - - <br /> --- (Complete in Duplicate) v Jf <br /> --- ... This Permit Expires 3 Year From Date Issued ate Issued -___ �`f/,�,7. <br /> Application is hereby made to the San Joa ,in Local Health District for a permit to con ruct a install the rk herein described. <br /> 1 This application is made in compliance dryly rd'r, n <br /> I JOB ADDRESS AND LOCATION .__-___ ! �- �r �EiP.� <br /> .__._ __-_•---___-_ <br /> Owner's Name '-------�� ---5 �----- •-/T7f -- , ~- Phone : '� <br /> ------- <br /> Address-----------------------------2:r L :23 a�Xk------- -------------577.111_e� <br /> Contr <br /> ddress-------------------•- <br /> Contractor's Name________________ -----------lt° - -__ Phone... <br /> OF <br /> r Installation will serve: Residence [21-Apartment House ❑ Commercial ❑ Trailer Court [] Mot I ❑ Other [] <br /> Number of living units: l Number of bedrooms _Z'.- Number of baths ___L_- Lot size •--- <br /> Water <br /> Supply: Public system ❑ Community system ❑ Private [EEDepth to Water TableAg�-C?_ ft. <br /> Character of soil to a depth of 3 feet: Sand [] Gravel ❑ Sandy Loam ❑ Clay Loam [9--'rlay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date.............-------) No ❑i--'_New Construction: Yes [❑ No [g---_FHA/VA: Yes ❑ No [3-- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: i <br /> I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic T A! Distance from nearest well__?. �.Distance from foundation-_ ` Material----- <br /> !d i <br /> No. of compartments__...,Z------__.--Size__.(cz�.�X--`Jf._Liquid depth ��r~ Capac,ty__ <br /> Disposa# ield: Distance from nearest we11__-. j~.-.-Distance from foundation_I5;;7-_-_____Distance to nearest lot line__ <br /> Number of lines-----------/ - Length of each line_.--_194_'_______-_.Width of trench.. ___••------------------ <br /> IJ f 1 <br /> Type of filter material.._- . �/ -.Depth of fitter material....> ----.-_._Total length____-{,1 --- <br /> Seepag Pif: Distance to nearest well_f�i�_.l.-.-..Distancem foundation-_rf�_f___.._.Qistance to nearest lot #ine._ �-�51'V <br /> Number of pits-.__-...f..........Lining material_., �zf ._Size: Diameter_._4�"_._..-.Depth..��_ <br /> Cesspool: Distance from nearest well___--------------Distance from foundation___________________ Lining material.-...__-..____._.- .............. <br /> El <br /> Size. Diameter----- --- ------- ......... Depth........... .--.----.-- -- .--.. . ----------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well................... .............................Distance from nearest building-, �! <br /> ❑ Distance to nearest lot line --- ... ............... <br /> Remodeling and/or repairing (describe):._.--- �/9at,�---------•---- <br /> --------------------------- <br /> ------------------ ro <br /> / -► <br /> ------------------------- ------- - -------------------------------------------------------------------------•-- <br /> ------------------------ <br /> ................ -- ------- ------------------------•----------- ----- Q.. <br /> 1 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, rules and regulations of the San Joaquin Local Health District. <br /> (Si ned <br /> 9 )------------------------ t�._��_-_,�%..�1Y.----...,�-rtC.�.-...-- - ------------.....-- ----------------------------- Own%Mand/or Contractor] <br /> By:.............. �r� � (Title)-------- - --...`. ------------ --- -------- <br /> (Plot plan, showing size o I�f o_o location of s sfe 3n 'relation t w <br /> 9 y o ells, buildings, etc., can be placed on reverse side)_ <br /> FOR DEPARTMENT USE ONLY <br /> l <br /> APPLICATION ACCEPTED BY................. <br /> DATE__-- =. ,r-Y <br /> ---------------- ----- -------------------------- <br /> REVIEWEDBY----------------------------------------------------- -- --------------------------------------- DATE-----••---- <br /> -- ...-------• <br /> BUILDING PERMIT ISSUED-----------------------_---------------------------------------------------------- -•-------_--- DATE-_----------------------------- <br /> Alterations and/or recommendations:__ <br /> -- ------- ............................. <br /> •--- <br /> ._.. <br /> ---------------- <br /> -- ........ . ......... ----------- . -------.---... <br /> ------ ------------------_--.- <br /> ...----- <br /> FINAL INSPECTION BY:.........0 .- ✓. ­­----------- .......... Date-------------- ' <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.CO. <br />