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FOR OFFICE USE: <br /> ----------- a 7 <br /> :i________________________1..: �'__._. ?LIGATION FOR SANITATION PEItiG1T Permit No. // `� <br /> ------•---•--•--------------------- --- ------------ (Complete in Duplicate) <br /> ___________________________________________________ This Permit Expires 1 Year From Date Issued <br /> 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 Ng�o,.. 549. <br /> JOB ADDRESS AND LOCATION.__._ -/_�___J ��4t /v / °- <br /> Owner's Name f+ f + �p� --------•----------------•------------------------------•-•---------•-- Phone--------- __...-...... <br /> Address 11�_ .......... - <br /> Contractor's Name------> T ............................................. ------------•------•-------- ------------- Phone.......................----------- <br /> Installation will serve: Residence ❑ rtment House Commercial Trailer Court Motel❑ ❑ ❑/ o el ❑ Other <br /> Number of living units: _�__- Number ofbe�drooms __^--- Number of baths �___ Lot size�l�_j / �.__:•______________ <br /> 11 <br /> Water Supply: Publics stem ` f <br /> y ❑ Community system v[� Private ❑ Depth to Water Table � ft. <br /> Character of soil to a depth of 3 feet:- Send❑ -Gravel [],,_Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ <br /> Previous Application Made: (If yes,date.__----•_-__--___-_.) No �lyew Construction: Yes �o ❑ FHA/VA: Yes ❑ No 11 1M <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 11 11 <br /> (No septic tank or cesspool permitted if public sewer is available w3hiq 200 feet.) <br /> Septic Tank: Distance from nearest well---- Q___Distance from found�at _ -----------�� Ca aci 1Z-oP___ <br /> Disposal Field: Distance from nearest well___.'Z0__ ..Distance from foundation__�Q___---- tagce to nearest lot line__.,`'___—__ <br /> Number If lines-..---,/ Length of each line_-X fW`_----__ __- CIA of trench_.'L__/:j_•-_-_- <br /> Type of Iter materia of filter material__` al,.Pength---lQfj___-----------_---___ <br /> Seepage Pit: Distance o nearest well--Z,40------ fro _fo�fop ., �-�__ ista e to nearest lot line_' '__ <br /> ®� Number f pits_._._____.______Lining material___ . ,40-,.Size• Diameter__ . ':__. . De th_ . .__' <br /> Cesspool: Distance from nearest well----------—__-_Distance from foundation____________________L�i�g material------------__-________..__________ <br /> ❑ Size: Dia eter-------------•--•--------------.Depth------------------------------- <br /> 4nea <br /> Capacity----------------------------gals. <br /> Privy: Distance from nearest well_________ ---___----------_---.__._ . - <br /> Distancebuilding_______________________________Distance to nearest lot line------------------ -•------------------0-1 <br /> Remodeling and/or repairing (describe)=----------•_—�- - - --- — ---!��_---- - <br /> / ------------ - <br /> ---­--------------._-_--------------------------- ---------------------------- ----------- <br /> I hereby certify that I haus pcepaced_this_applicatior�i'.al�d_#hat_the work will be done.itaccordance with San Joaquin County <br /> ordinances, Stateglaws, and rules and regulations of the San Joaquin Local Health-District. <br /> . 1 <br /> (Signed) - ------ •-E•- --• - - .-'�, Contractor) <br /> --- ----------------------------- --------------------(Title)----�����-'`------------=--------------- <br /> (Plot plan, showing size 14lot location of system elation to wells, buildings, etc., can be placed on reverse side). _ <br /> - f _ <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_______._ .-�___._•. .........-------- DATE._ —3-7--`*7 <br /> REVIEWED BY--------------------------- <br /> --_-.------- <br /> -------- <br /> -------------- <br /> ------------••- --•---------------------------•--------- DATE <br /> BUILDING PERMIT ISSUED------------------------------------------------- ------ DA•TE__- ._ --- --- - -- - - <br /> Alterations and/or recommendations --X9.._2_._..__._--(1,.� -C ---- 1/�--------- <br /> .................------......... -•-•---•-:-`~--••--•----..........__.........------------•.__._.�-------7--i-----------—----------------------------------- <br /> FINAL INSPECTION BY:...__.. .: .- <br /> ....--�-•- --�-'�✓`�--- -•--- ---... _ Date------------ ------- .................................................. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICTS <br /> 1601 E. Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> 1.P.Co. <br /> . _. .. -rM^'^^R.►-.�.i�..a.ne.rw.,�gtrnR.....-n.<w.T..r.=�.,nm�.ao�a�a,sn.... <br />