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. .... ...... .... <br /> ------ - ----------- -- ` 1 <br /> ROLICATION FOR SANITATION PERMt Permit No. ... ..�l.......... <br /> - <br /> -- ------------------------------------.------------ (Complete in Duplicate) Date Issued ---- <br /> ----- ---------------------------- ------ - -------- <br /> ------_--_------._--------------.-._.-__._..-. This Permit Expires 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 /> ,(/ y� ----------------- `__ `� <br /> _ JOB ADDRESS AND/L,QCATI N/...._...!....�' �4j_C !--_ _. .. -`--_ --�== !w ---- <br /> Owner's Name-------- /- "-b':_- 44.x!ax...--------------------------.-------�......_.--------.-- Phone......-------......------------ <br /> Address.---_- �r� few"�_f�� `� --1j, '� <br /> - - - - - <br /> n' Contractor's Name.............- - - ----------------------------I�.� PPhon r f---------- ----- <br /> ---- ------- <br /> zv <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court Motel Other` E]_ Number of living units: -..f. Number of bedrooms .__�` Number of baths ... -- Lot size ." f' =a- :.` 7----- -=------- <br /> , <br /> Water Supply: Public system ❑ Community system ❑ PrivateK Depth to Water Table__. . ft. l <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe❑ Hardpan ❑ <br /> r Previous Application Made: )If yes date._....._.._....-) No � New Construction: Yes o ❑ 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 /> L. <br /> Septic Tank: Distance from nearest ........ <br /> well ---- ............. ..._.. <br /> ( No. of compartments..._. -Size9,A_/V.x _Liquid depth___.-._-._�Capacity-,/.�Q.�--- <br /> Disposal Field: Distance from nearest well_._.70--._Distance from foundation----________________Distance to nearest lot linyl_:�U....__ <br /> h"' Number of lines---.__,.�...�__. __ g ---- <br /> ___.__y._Length of each line...,---- Width of trench...,-1._...;7. - <br /> ____ _--------- <br /> Type of filter materi8'L d=r.P:<-fl-Depth of filter material:_=.:_ --------Total length------1.rS.:'U------------ ------- <br /> Seepage Pit: Distance to nearest well Distance from foundation---------.---------Distance to nearest lot line................. <br /> 6. ❑ Number of pits---------------------Lining material?wl---------------.---Size: Diameter-------- -------------Dept h..._..-._.._-__--------_-.--- <br /> Cesspool: Distance from nearest well.---------------.Dista"nce4forn foundation-------------------Lining material--------------------------...... <br /> El Size: Diameter------------------------------- ----Depth ` - -------- -------- ------------Liquid Capacity--------------------.. gals. Q <br /> 6e _____._..Distance from nearest building Privy: Distance from nearest well---_-.-------_---------------- 9---- ----'--------- <br /> ❑ Distance to nearest lot line----------------------------------------------------------------------_---------------------------------_--------..-------_-------- S <br /> Ir Remodeling and/or repairing (describe):---------•----'----------------------------------------------------.__....-----_.---------------- <br /> ---------------------'------------ -----`----'-------------'---------'==-'---------------- • ----------- --- <br /> 4.. . . - - -----_..............--------------'---------------.......--------------------- - <br /> --------------- ----------------------------------`--------------------------------------`--------------__----------`----------------------------------------------------------------------------- <br /> -- <br /> I hereby cert' that 1 have prepared this application aA that the work will be done in accordance with San Joaquin County <br /> ordinances, Ste I ws, and rules d to }dations of the San Joaquin Local Health District. <br /> _ <br /> (Signed)___---. .tnn-. -- / ...- --.Owner and/or Contractor) <br /> ---._...---f--------------------------------------------" ( / ) <br /> BY: - --------------_--- -- - - -- ------------------------- ---------------. (rifle)----_----------------------- <br /> (Plot plan, showing sae of lot, I cation of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---------------------------------- - ----------_---------------- DATE-------------------------------------------.------ <br /> REVIEWED BY----------------------------------------------------------------- - -- - _ DATE------- ` <br /> - <br /> - --- --- ------------ <br /> ------- ---- <br /> BUILDINGPERMIT ISSUED-------_-------------------------------------- - -- - ._....-----.... DATE--------- ------------------I----------------- <br /> Alferafions and/or recommendations:------------------------------------------------------------------------------- ------------ -------------_----------__--------------------- <br /> ---------------------------------------- <br /> - -------- ------------- ---------------- <br /> L ---------------------------------- <br /> - - --- --------- -- ---- -------- ------------ - ------------- <br /> FINAL INSPECTION BY:._._.... ._ - l-- -- Date.------._/__...:._1.. .✓ --Z------------------- <br /> LSAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxelton Ave. 300 West Oak Street 144 Sycamore Street 405 West 9th Street <br /> Stockton,California Lodi, California ` Manteca,California Tracy,California <br /> CS 9 RCVISEO B-59 3M 3-'63 i.P.CO. `� <br />