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- - - - <br /> _.-. APPLICATION FOR SANITATION PERMIT Permit No. ------- <br /> -- <br /> . <br /> -------- (Complete in Duplicate) -s_ <br /> _ This Permit Expires 1 Year From Date Issued 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 /> LJOB ADDRESS AND LOCA ON_----- '` _ - <br /> Owner's Name----- / 1.U..(� �d_czr/�LL� G '---------/---- ---- ..... ------------------- - Phone------------------------------ <br /> Address <br /> _.._ _ _ I �:f.lE _ .�" rr� �C' .. �L-= <br /> LContractor's Name-------1.4 91_eL7---- QQ, ----------_-------------------- - <br /> Installation will serve: Residence Pi--Apartment House p Commercial p Trailer Court ❑ Motel ❑ Other ❑ <br /> ` Number of living units: __/_ Number of bedrooms _— Number of baths _r... Lot size . 741/; ,Oe - <br /> Water Supply: Public system ❑ Community system ❑ Private B'-Depth to Water Table it9 ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel p Sandy Loam❑ Clay Loam p Clay ❑ Adobe Pq`�Rardpan❑ <br /> L Previous Application Made: (if yes,date_.___ -------I No [ New Construction: Yes ❑ No ( , FHA/VA: Yes ❑ No <br /> TI— <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) C <br /> L Septic Tante: Distance from nearest well-----------------Distance from foundation....--------------Material.,_.___....._----------------------------- <br /> � <br /> 1S No. of compartments...___._.__.._ __._Size_...___.__.___. _Liquid de th____.__-.__. Capacity. <br /> i <br /> Disposal Field: Distance from nearest welL_ ? __Distance from foundation__a1 ._.__..Distance to nearest lot line_._,$-� <br /> __.__._... <br /> L Number of lines____-__t..�..__ .. ,Length of each line 3.8�_. _.. Width of tench_ _ _,_--....--_-_� <br /> i> i <br /> Type of filter materia!_��._. :Gt�Depth of filter matenal_.��.____.Total length_._��__.:..___________.._._. <br /> /rtY i <br /> eepage Pit: Distance to nearest well__ �_�._Disfance from foundation___ .____..Distance to nearest lot line_--------.---_. <br /> Number of pits-__/-------- _Lining material.___ Size: Diameter.___ '9_-__....._Depth.�'__ �_________________.__ <br /> Cesspool: Distance from nearest well---------_._..Distance from foundation_----- ._----._Lining material----___.._.._--..___.__._. <br /> L ❑ Size: Diameter-- ------------ -------------_Depth--------------- ----------------------------Liquid Capacity.------------------------ <br /> -9 <br /> Privy: Distance from nearest well------- _.--------------------_-----.___Distance from nearest building----- -------------_-----__.____. <br /> ❑ Distance to nearest lot line . --- ____.._.___..____._.__-- ---------------------------- -------............. <br /> LRemodeling and/or repairing (describe):-------- _�----.------__--_-----.---------------_----------_----._-- v, <br /> -------------------------------------------------------------------------------------------------------------------------------------------------.-. .._---......----.... <br /> '----- - - --- ---- - - ---- --- -------- ------ -- -- <br /> - - -- - - - - - - ------------------- -- - -- --- - - - -- <br /> ' <br /> L -- - - -- -- `--- - - --`--- - - -- - - <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 /> L (Signed)---------/A'-6 .:® rr� /6-- ---------'----- -- ---- - - -- --(fir Contractor) <br /> ----- ---------------- <br /> By=----------------------------=---------------- --=----- - -------------------(Title)-- �/ `------ ..... ----------- <br /> L (Plot plan, showing size of lot, location of sysfe relation to wells, buildings, etc., can be placed on reverse side). <br /> >`i PARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY __ ` _ __ ..- . . __ DAjTE -fB -y17. .. -_ <br /> lv, REVIEWED BY. v.>_ .-_ DATE .------------------ <br /> _- <br /> BUILDINGPERMIT,ISSUED----------------------- --------------- --------------------------------------------'-- _ DATE------------------------- <br /> Alterations and/or recommeddations -?---------------------'-----" -------------------------------------------- ---------------------------------------------- <br /> L ...----.....-'------------= -----`---'------------------` - - <br /> ---------� -a 3- -=- _ _ - ------- '---- ------- ---------------------------- ------------------------------------------- <br /> ----------------------_..._... . ------------- - ------ ----'--------------- -- --- --- --- -- --- --------------------------------------- _------------------------ --- <br /> L -- -- - - - --' - - <br /> --- --------- - <br /> FINAL INSPECTION BY:--- - `` - - - Date-------.: .- -9 ----------- ­---------------------- <br /> L $ANAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Ook Street 124 Sycamore Street 205 West 9th Street <br /> Stockton, California Lodi,Califarnia Monte.,Cnlifornia Tracy,California <br />