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1 -LICATION FOR SANITATION PEf iT Permit No. ....` .. .... <br /> --G (Complete in Duplicate) <br /> -- - --- -- ----" - - Date Issued ..... <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 <br /> No. 549. <br /> JOB ADDRESS AND LOCATION- 1) - -------/�� � C l ------- ------------------------------------.----- ---.- <br /> � � _ 1/� �• <br /> Owner's Name......... - -----r--'-------....-----------'---'-----'---.....`---'--`-- Phone_.--'-•-----------_.._...... <br /> Address---------- ------------------- <br /> Contractor's Name--------------/�jt k'a -- - - -- Phone <br /> Installation will some: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: .... Number of bedrooms . -. Number of baths �. Lot size + -------------------- <br /> Water Supply: Public system Community system Private �vepth to Water Table ft. <br /> E] [Ibe <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe iardpen ❑ <br /> Previous Application Made: (If yes,date ) No ❑ New Construction: Yes ❑ 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 /> Sep}�Tan y Distance from nearest well-----------------Distance from foundation--------- .-----...Material................................................ <br /> vJ / No. of compartments -`...._ ............Size.------......----------....Liquid depth.......----------------Capacity...........`-�-/ <br /> zL <br /> Deposal Figl - Distance from nearest well.4dfP...'_Distance from foundati �Q..�..Distance to nearest lot line........ <br /> / / Width of trench .A........................... <br /> Cj�fr�y Number of lines................... ... ��ILength of each line--- -�.--.--.....-.... <br /> Type of filter material. - Fd/[pepth of filter materia. - --- � Total length �� 9 <br /> - <br /> 'V <br /> Seepage PDistance to nearest well....eW ---/-Distance frmfodation---l �........Distance to nearest lot line <br /> - <br /> 3- - <br /> Number of pits------/------------Lining material.- Q4Ae'_CSize: Diameter.„Vi -------Depth.. 2,i:�7i...... ............. <br /> Cesspool: Distance from nearest well-----------------Distance from foundation.---..-_----------.Lining material----------------_-.................. <br /> . <br /> ❑ Size: Diameter--------------------------------------Depth---'-----------------------------------------------Liquid Capacity_---'-'-'------------'--..gals. [r <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---...-....-------------__-------------- <br /> ❑ Distance to nearest lot line------`----------------- ---- -------.........-------------------...-------------------------_---------- \ <br /> Remodeling and/or repairing )describe):----------------ev .-�.... - - �C <br /> .............-------------------------------------'------------------------------------------------------------ ----------_-----------_-..-...-"------------------------- <br /> - - -------- '-- -----......”-'-------..........' ----'---------------------I——----------------------------------------'----------•------------------------------------------- <br /> I 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, and rules and regulations of the San Joaquin Local Health District. <br /> __Owner"an�Yt or-Contractor <br /> (Signed)------------------------- ...-....`— - - - ( / ) <br /> B ............................................................... '--~ ....(rifle)--- <br /> (Plot plan, showing size of lot, location of system inA tion to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----- •-.."7 -a ------ - ---­------------- ............................. DATE.... ........................... <br /> REVIEWEDBY............................-----------------------------------------------_------- _-----------------------_--- DATE......................................................... <br /> BUILDINGPERMIT ISSUED-------------------------------------------------------------------------•-_-•-------------------- DATE................................. ....................... <br /> Alterations and/or recommendations:--------------------------------------------------------------------------------- <br /> ------------------------........ ----------------­----------------------- <br /> FINAL INSPECTION BY:. _..--5 5- ............................. Date-----. 2..GT--b 1....... .....................-............ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 We,t Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca, California Tracy, California <br /> ua ecvrem s-ee r.n.c o.ar a"ea <br />