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...................•---...-• <br /> .............._..................... APPLICATION FOR SANITATION PERMIT Permit No. <br /> r (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. �y <br /> JOB ADDRESS AND LOCATION--- . �J- --- <_G.t / '_..-._,f< C-- x _... '. <br /> Owner's Name Q - .-t-l"ass-----------�------ Phone....1jC <br /> Address . Q_.1`--------- -- �--.---��'.,�- � ���1 411/Y._-�-------�9�. <br /> Contractor's Name------$.. ---•--------------- ------_---------- --------- ---- - - ------------ ----------- Phone----..-C ._ .... <br /> Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _/_.. Number of bedrooms .3.. Number of baths _Z_ Lot size _... _ A?..C,. ........•.............. ._-.- <br /> Water Supply: Public system ❑ Community system ❑ PrivateA Depth to Water Table . .- . 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_._---____ _ . ) NoA New Construction: Yes No ❑ FHA/VA: Yes ❑ NoX <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 well--- sU-----Distance ffomioun>tion_ _.... Material ... _C/V�i.Y•F..j`- <br /> No. of compartments__.__.. _ <br /> 'r4------------Size.- ---40.. -. S: .Liquid depth .?--f '. Capacity l <br /> Disposal Field: Distance from nearest well....�O_f...Distance from foundation-_- f�'�._...._Distance to nearest lot lin),_.. �_ - <br /> Length of each line__ <br /> Number of lines .__._ '3....... . ..........•--Len .__�_r <br /> 9 O tl Width of trench -------•-_--- /\ <br /> Type of filter material_Cr_4_i' e./__Depth of filter material__ /__..._.._..Total length_____'. ��_f................. G <br /> Seepage Pit: Distance to nearest well......................Distance from foundation.......------------.Distance to nearest lot line ............... <br /> ❑ Number of pits.--------............Lining material-------_............. Size: Diameter-----------------------Depth................................. <br /> Cesspool: Distance from neare3t well................Distance from foundation................. ..Lining material.-.__-.-.-_-_--___-_-___----.____-_._ <br /> ❑ Size: Diameter- -- .............. ................Depth..----------------------- ----.._...----------•--.--Liquid Capacity-------------- .............gals. <br /> t well.................................. _._. .----.-Distance from nearest building......................................... <br /> Privy: Distance from nearestDistance to nearest t lot _ __ line____________________.____-._...._.____._._......_ <br /> Remodeling and/or repairing (describe):-............................................................. <br /> -•---------------•---•------•--------............................................... <br /> --------------------------_.......................................—-------_.............--•---••--•................................•-•--------------•-.----- <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 �rgulafions of the Sa Joaquin Local Health District. <br /> Si ned i�l _._-Owner and/or Contractor <br /> �J � <br /> By------------------- - ------ ------------ ----------_ --------- -- ------- ......-------------------(Title)---------- --- - - -----.--- _ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.--- cL L� t' L .. -------- - ------------_ DATE....,-//� (�' .-. --------- <br /> REVIEWEDBY . - ------------------------------ ---- ------------ ---------... ------------------------- --- ------------ DATE_................ ---•- <br /> BUILDINGPERMIT ISSUED-------- -- -------------------------------..................----------------_------------------ DATE............................................................ <br /> Alterations and/or recommendations:........................................................................................................................................... <br /> ••••••••-••---•------•.............................••••--•--...--•------•--•...-••••---•-•--•-•----------••----•------•-•---•-•---•--------.•....._..-•••••-••-------•---•-.•••-• •-----•••..-••••-•-••----••••--•-•••••..... <br /> --••••••-•-•-.•---•------•--•........................••••-•-••--•••-•--------..•---••--•-----------•-------•----••---------•-------•-•--------.....----•-•-•-...--•--------••--• •-•-•------------•-••-•-•-•-----...-•-•-••- <br /> ..............•---•--••-•-•-----. ._........ ...... . ---••••-••••------••-----•---------•--••-•..................................................................----- - -------- ............................ <br /> ----•------••-----------•---•---------------------------------•--•---------.---.----...... ..-------------••-•--•-•-•------------------ <br /> FINAL INSPECTION BY:...`_'_-.>.`L'S-..... .. _1&C------ Date..... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <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 /> F H 97M 1-67 Vnn­..r4 Pro« <br />