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3_'.' APPLICATION FOR SANITATION PERMIT Permit No. .. <br /> (Complete In Duplicate) / <br /> . . This Permit Ex fires 1 Year From Date Issued Date Issued ....��5 <br /> ' Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describes , -{ <br /> This application is made in compliance with County Ordinance qN�o. 549. /� <br /> JOB ADDRESS ANDLOCATIQN .{.'! ... GC fo rQ.T ... nw� <br /> y tl <br /> Owner's Name. - .........--- _. .............................. Phone---....... ............ <br /> /� _..._....--................. <br /> Address---•��>f ..1!/.... K , <br /> Contractor's Neme. X....................... .... ............................ ...................... Phone........... ..................... <br /> . t <br /> Installation will serve: Residence 05'�'Aperfinent House ❑ Commercial [ITrailer Court ❑ Motel ❑ Other [3Number of living units: 1,...,... Number of bedrooms..1. Number of baths .j2..- Lot size .../.Q ............ e <br /> Wafer Supply: Public system ❑ Community system ❑ 'Private 'Depth ro Water Table .AP ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay❑ Adobe Hardpan ❑ <br /> Previous Application Made: (if yes,date....................) No � New Construction: Yes 92( No ❑ FHA/VA: Yes �No E111 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> ' Septic Tank: Distance from nearest wellQ........ Distance from foundation./P............Materia l.. ...... -..-,--,--../ <br /> No. of compartments.......vZ....--_-------size...�_Xsx-7..--.--Liquid depth....._ -------..Capacity....Q� �1 <br /> V­-4 <br /> Disposal Field: Distance from nearest well.47.4.........Distance from foundation-A?.............Distance to nearest lot lines...... <br /> Number of lines.------ ......-.....Length of each line....7.. ............Width of trench_f f`'....- <br /> Type of filter materia., 0-cr..' .........Depth of filter material..41.................Total length....J.S .....-..---... <br /> O ` t <br /> / . <br /> Seepage Pit: Distance to nearest well..A!.,f.........Distenc from foundation..«1...�........Distance to nearest lot line...:�V.....,+: <br /> p <br /> Number of pits.....................Lining materlal..l.. G/.�...._.Size: Diameter...�i............_...Depth....��_.............. <br /> _,. <br /> Cesspool: Distance from nearest well.................Distance from foundation----.------- _....Lining material..............._. <br /> ❑ Size: Diameter-- .......... ..... ..............Depth.......... ...............................-----..Liquid Capacity..........._........ gals. <br /> Privy: Distance from nearest well-------.........................................Distance from nearest building.. <br /> �tstance to nearest lot line:----.--..•................. \rk <br /> .................... <br /> Remodeling end/or repairing (describe):.R � �• �! - r6 4usLO /S o ►is 6 <br /> .... - .. . - .... - ............ .......- F-0--•........................ ..... <br /> .............................................•-----------------...---......-----.......'--•--................................-................................................---......................... <br /> - ..... <br /> :................. ...............---------­- ......................................................................_...------.........-.......•. ........------............................. <br /> ........... - ........•..........................................................----........------ -- - .... _------ <br /> .............. .......... <br /> - .... .. <br /> 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- re ulations of the San Joaquin Local Health District. <br /> (Signed)_......................................... .. .._� --- -- - _. .......(Owner and/or Contractor) <br /> By:... - ----- —:--- -- - ----------------- (rtl.)............. <br /> (Plot plan, showing sae of lot, location of system in relation to wells, buildings, sic., can be placed on reverse side). <br /> FgR DEPARTMMT USE ONLY <br /> APPLICATION ACCEPTED B ... _... ..._............... DATES <br /> -.........-------- <br /> REVIEWED BY- ................... - ...... .......... ... -- ----- - - DATE............................... ........................ <br /> BUILDING PERMIT ISSUED,..................... <br /> - - -- .... <br /> DATE <br /> Alterations and/pr recommendations:.-•7 f-Q .. .Er ----------------------------------------------------- <br /> ... ..................- _ ...... - N <br /> ........................................................................ - <br /> - ....................................................................................................... <br /> ...._. m <br /> . <br /> ............. ............ ----- ...._...... ... ................................-.......... ............................... <br /> ......... ... _ <br /> FINAL INSPECTION BY - - -- - Date, .J ..r .a4 <br /> r <br /> SAN JOA IN L L HEALTH DISTRICT (((///���/// <br /> 190 South American street 900 Wen 09 Street 124 Sycamen St 1 205 Wotl 9th Street .� <br /> Suidnan,California Lodi,Califamla Manteca,California Tracy,California <br /> Cis 9 REV18E0 8.89 2M 5-62 ATu ' <br />