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y7� ��-- ----- ----�13 - <br /> ..... .. ....._------------- ------------- ------------- A,,,LICATION FOR SANITATION PERI` d Permit No. . <br /> ------------------------------------ ------ (Complete-in Duplicate) <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 /> JOB ADDRESS A LOCATION.--.--...T. .el - <br /> _ ----------- ------ ----------------------'--......--'-----... <br /> Owner's Nam`e1..�----------- - ........ - - — - - - Phone- - -- - <br /> AddressT 7 - ---------. ............- --"............................ <br /> Contractor's Name - - - ------ . .... -------------------- Phone.................................. <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial (/Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ------Number of bedrooms Number of baths.../.. Lot size ----- ... .------ ..........................--......_.-- <br /> Water Supply: Public system ❑ Community system ❑ Private /[Depth to Water Table ------ - ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam [-] Clay Loam ❑ Clay a Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date. ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic ank: Distance from nearest well �oDistance from foundation----&-..........Mateal <br /> No. of compartments_-_ -..-- -----. . .Size.� Liquid depth_. .--ri---- <br /> -------- <br /> vCapacity <br /> -,ka ..iz........... <br /> Dispos Field: Distance from nearest well- ------Distance from foundation..._46......-Distance to nearest lot Iine.S.' <br /> P96 .. <br /> Number of lines..........I.-------------------Length of each line-. ----fCC -........-Width of trench.--2.�-._7.....--.------- <br /> Type of filter material......t9.�--------Depth of filter material--_ tft..........Total length.....--`..ftst........._------------ <br /> Seepage Pit: Distance to nearest well---------------------Distance from foundation....................Distance to nearest lot line-----..-......... C <br /> ❑ Number of pits... -----------------Lining material--------_____.-_.- Size: Diameter------------- ........Depth--------------._-.._.-.-.-. `` <br /> Cesspool: Distance from nearest well--.---------.-Distance from foundation----------------..Lining material-------_----------------.......:.... C <br /> ❑ Size: Diameter-- —---------------------------Depth-------___-------------------------------------Liquid Capacity---------------------'--gals. <br /> Privy: Distance from nearest well--------------------------------.----- ------...Distance from nearest building_-------------------_-..- <br /> ❑ Distance to nearest lot line------------_WW----....----------------------.___----..._.--.------------._........................... <br /> ------ <br /> Remodelingand/or repairing (describe):----... - -------------------------------------------------'------------------"---------'------------_----- -----------...... <br /> - ---------------------------------- - - --------------------------- -------------------- ---. .......W-...----------'------------------........---------------_---------- <br /> I hereby cerfif I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, StatUws, d rules and regulationsof the San Joaquin Local Health District. <br /> (Signed)--------- _.__----------'-- ------------`-------------- for Contractor) <br /> By:.....---- ----...... `....------------- -------- ----- ---------------..........._....(Ti+Ie) --------_w_-_--------------- -._...... - <br /> (Plot plan, showing size of lot, location of Sys+ m in relat n to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY (� <br /> jL <br /> APPLICATION ACCEPTED BY--.. - --- ----------------- "---------- DATE.. f -L(v 6 -..------------------------ <br /> REVIEWEDBY......------------------ ------------- - ----------------------------------' ----------------- DATE----- --------------------------' - <br /> BUILDING PERMIT ISSUED------- ' -'------ -- -----------'------------__------------------------- - DATE---------------------------•---...- <br /> Alterations and/or recommendations:------ -----`-------- ------`--------................................................'---....---...._..__........W--.............- <br /> ----------------- -------------------'-------......-.......-...---......--- .......... -...--------------------------------------- ----------------.............. --- ---- -------­--- <br /> - - ------------------------W.............. .. .. -- --------------------------- ------------------------------ ------ ... - <br /> FINAL INSPECTION BY:....T.". v- - - -.... - Dete .I �7 / �O 0- ---------- <br /> SAN <br /> - -SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9rh Street <br /> 51a6ton, California Lodi. California Manteca,California Tracy, California <br /> E.H.92M 1-67 Vanquard Press <br />