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1-UK LR)L: <br /> .......................... C) <br /> A&LICATION FOR SANITATION PERMIT Permit No., ! <br /> -------------------------_..........­­------ ---- (Complete in Duplicate) 2 <br /> T------------------------- ------ ---- --- -------- This Permit Expires I Year From Date Issued Date Issued L__1_ <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work kerein.clescribed. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION_- -_C- -- --- --------- ......t4e <br /> Owner's Name--_Ij' -------------- -- - --------- ---- --- ----------------- Phone--rl-/ <br /> Address /02,2 - - ---------4----------------- <br /> ----------e . <br /> Contractor's Name-.---------------------------- �------------ - --------------------------------------------- <br /> Phone-------------------•----- <br /> r- Installation <br /> hone-------------------------Installation will serve: Residence x Apartment House E] Commercial [] Trailer Court El Motel [] Other E] <br /> Ne <br /> Number of living units: _2--- Number of bedrooms ---/- Number of baths _�---- Lot size ---------- ------------------ <br /> Water Supply: Public system El Community system El Private 0( Depth to Water Table WSJ If t. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam El Clay Loam E] Clay F] Adobe-0 Hardpan E] <br /> Previous Application Made: (If yes,date--------- ---- ----) No K New Construction: Yes g No El FHA/VA: Yes ❑ No [9 . <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> r. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well--6-0------Distance from foundation---/Q---------Material-------co._� <br /> No. of compartments----- - ---Size__,OX_ 7_x_1 _,___-----Liquid depth____._._ 46! Capacity � --- <br /> Disposal Field: Distance from nearest well...�Dq......Distance from foundation.-/6---------Distance to nearest lot <br /> Number of lines_____________ <br /> ,7. Length of each _544?.Width of french------A- `-------- ------------ <br /> .......Total length--------0-a_a------I--------------- <br /> Type of filter material---- Depth of filter material <br /> Seepage Pit: Distance to nearest <br /> well___/9---------_Distance frpm fgunciation--/�-'-.---.Disfance to nearest lot line----t3 ------- <br /> Number of pits.---d - ---Lining material--- Diameter__%;7!-7_ D,pf h....C X.-S-7-" ----------- <br /> Cesspool. Distance from nearest well-----------------Di,tance from fouridafio------ - - ----.-_.Lining material___.__..____.._____._.._________..__. <br /> ❑ <br /> aterial--------- ------------------------- --- <br /> F1 Size: Diameter--------------------------------------Dept h- --------------------------------------------------Liquid' Capacity----------------------------gals. <br /> Privy: Distance from nearest well-- ______ ____ _------------------------------Distance from nearest building..___..__..______.__._._______._-.-..____ <br /> Distance to nearest lot line-- ---- ---- - ---------------------------------------------------------------r----------------------------------- ...... .. ..... <br /> Remodeling and/or repairing (describe):------------------------------------I------------------------------------------------------------------------------------------------------------------- <br /> -----------------I.,----------------------I---------------------------------------------------- --------------------------------------------------------------- - ------------------------------------------------------------ <br /> - ------------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <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 /> F (Signed)----- ---------0--- ,----------- -------------------------------------------------------------------- -----------------------------------------(Owner and/or Contraefor) <br /> 7'..r; .5, , . - -_ _------------------------------------jif le)---------------------------------------- --- ------------------- <br /> By.<------------ -------------------------------- <br /> (Plot plan, showing size oMot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> t Ir-.. <br /> APPLICATION ACCEPTED BY------ -- --------- --- - ---- -------- DATE------ ---------------------- ---------------------------- <br /> - <br /> REVIEWEDBY-------------------------------------------- ------------------------------- --- ---- --------------------------------- DATE----- <br /> BUILDING <br /> ATE-----BUILDING PERMIT ISSUED--------------------------------------------------------------------------I------- ------------------ DATE--------- --------------------------------------------------- <br /> Alterations and/or recommendations--- ------ --------- ------------------- ----------------------------------------------------------------------------------------- ----------- ------__------ <br /> F4' - <br /> - <br /> - <br /> -------------------- --------------------------------------------------------------- ---------- ----------------------------------------------------------------------------------------------------------------------------- <br /> ---------- ---------- --- ------------------- --- --------------------------- ----------------------------------------------------------I------- -------------...... -------------- -------- <br /> - <br /> -- <br /> ------ ---------------------------- <br /> ------------------------ --------------------------------------------- - - ------------------------ -- ------------------------------ ------------ ------ -------- ------------------- <br /> - - - --------------- ----------------- <br /> -------------------------- ------ -- - -------------------------- -------------- ----- ------------ ------ ........ --------­-------- <br /> - <br /> F FINAL INSPECTION BY:. Date.- <br /> / _ -------------------- - -------------------------------------- ------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 1,llazel,on Aye, 300 West 0,31 Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.Cn. <br />