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FOR OFFICE USE: <br /> Permit No. <br /> APPLICATION FOR SANITATION PERMIT <br /> _ ._--- <br /> (Complete in Duplicate( Date issued ,7 <br /> ....... .. <br /> — PP . <br /> This Permit Expires 7 Year From Date Issued <br /> ses Application is hereby made to the Sen Joaquin Local Health District for a permit to cons Putt en install the work herein descrb <br /> This application is made in compliance with County Ordinance No. 649. D, <br /> /� ' . ..- --'-'- -- fi'�--:'--•.................. <br /> JOB ADDRESS A LOC.,sAsTION. 5 -��^-.------- - / - <br /> Owner's Name.-- --- -i-'f''s-''-�p Qt. + Y1e�t/-----.._---.... --..._ _._....----. Phone................. <br /> Address.-------- F -•?. �House <br /> " Phone._-.. Conirector's Name.-_.Im+ella#ion will serve: Residence Q Ap ❑ Commercial ❑ <br /> Trailer Court ❑ Motel ❑ Other <br /> Number of living units: .`-_'.- Number of bedrooms -------- Number baths -_7.-- Lot size ...... -. .- r <br /> •t <br /> Water Supply: Public system ❑ Community system C1 Privets Depth to Water Table/. ...- ft. <br /> Character of soil to a depth of 3 fe0: Sand ❑ Gravel [I Sandy Loam❑ Clay Loam �►r Cley❑ Adobe❑ Hardpan❑ <br /> Previous Application Made: (if yes dote.....................:) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes❑ No❑ <br /> i <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permi#ed if public sewer is available within 200 feet.} <br /> Seseeptic Distance from nearest well-.". .o.-""---Distant�e front+ foundation--../..�..........14+1ater�I... Capacity.. Q" -- N <br /> . No. of compartments......Al" --_-..---SizeA.X_4"._A_.'L Liquid depth"..-.-•�-- -6-' � W <br /> r <br /> Dispos field: Distance from nearest well_... Distance from foundation....�A.......--W Distance <br /> oofttrench est lot...fine......... ...... O <br /> -,--.--Len th of each line..-._".//yy�..- <br /> Number of lines.._------------'........... 9 `.. J•-'/----- / <br /> Type of filter materiel._.....%&R•----Depth of filter material.."".../".�------•--Total lengfh_"_ �-".._:....-.....--_"----- <br /> Seepe Pit: Distance to nearest well <br /> res .-.:Distance from�j°undation-. tAIII-L.....Distance toDnea+hstAlo��e-. <br /> Number of pits.(....../-_.--"".."Lining mY.G./---Size: Diameter..vl - - -- P <br /> *' Cesspool: Distance from nearest well..............._Distance from foundation_............._...ening material.__......"._..."..-......_.-.-_ <br /> ❑ Size: Diame+er".(.. ------- --------Depth------ -- ---------i--•-----.Liquid Capacity..-------------------gels. <br /> Distance from nearest weiL--.....--""-."...-""---.--"-.-- --"---.Distance from nearest building..................................._-.-. <br /> Privy: t .........---._.. C% <br /> Cl Distance to nearest lot line."..-...---.-- --------- •••••--"""--"'-" <br /> tZ <br /> t y <br /> Remodeling and/or repairing (desaibe):.-_'.....----'--'--'-'--.-----_-.....--.-.....--'-----------'---...-..=._.,-_.. ................... <br /> .._-----... P <br /> if <br /> ..--.-_._._:..._..•---_".--.-------..-`---•--��•-------'-------'-'—..........__-.'-"'----.._...............•___-__-.-.-. -..--.-.--.......-_-."-.---.-_._-'-"_..."__"".----- <br /> �' ..............................__..--__--.--..-.-_-i."--._._--.._---."-----...-_--_-_----....---.----_.....-------..--.....----.....--..-. ". __........._._-_i--••---_".....".................-_........_................•..........••---•_-•-.---.."---•----_.....-"-.................--.." <br /> ......_""...................""--.""_.-................. <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 /> ( tract <br /> or) <br /> (Signed)--....-' ----'--•_•.................----....................40wner and/or Con <br /> ..._._.....- <br /> By:-.. - <br /> see (Plot plan, showing size of lot, location of sys#em in relatifin t wells, buildings, eta, can be placed on reverse side). <br /> + FOR DEPARTMENT USE ONLYses <br /> ' <br /> APPLICATION ACCEPTED BY---- -_ ---.."...------ <br /> i DATE-.....-..-------------.._--- - -----.-._... <br /> REVIEWED BY------------------------------- ._.............. .. ---- .- - -- <br /> --..............._----•--- DATE..--.-.-.-.----------------------------.-._.------. <br /> BUILDING PERMIT ISSUED...........t.....................-.- -- - _........ <br /> ....­ <br /> Ise. ....­.......­...... <br /> -.."..-_.......-. <br /> ..--...---.....--..-._ <br /> it Alterations and/or recommendations:"..-...._...-.-....-- _.-._.-'---...___._....---.-... <br /> .-.."...............................•'----...........-.---'-------'-------_•...".--...._..... <br /> --.._..- ....... <br /> . -................._.......... ...........---.."..---...---....-.." <br /> ....... ..... ..... <br /> - <br /> .1 .__. ........_.._..........__ - <br /> FINAL INSPECTION BY:....- . <br /> ... SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Maralton Ave. 300 West Oak Street <br /> 126 Sycamore Street 205 West 9th Street <br /> lodi,Califernio <br /> Mameca,California Trocy,Colilernio <br /> Stockton,California <br /> co. <br />