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FOR OFFICE USE: <br /> - 1� 1-5-- <br /> A PLICATION FOR SANITATION PERMIT Permit No. . <br /> ......................... .. ............ (Complete in Duplicate) <br /> Date Issued <br /> _____ ... This Permit Expires 1 Year From 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 AND OCATIQf <br /> Owner's Nome. ---- -�-------• :1�._ E"_ (.�0 .. �.... ��S �L`. --•----. Phone................................ <br /> Address................•. •••••. --- .. --•-- . . .. �,..r a------------------------ ---------------------------------•-••"-------------------_----------- <br /> `1 ,// <br /> Contractor's Name........_--��a-�iius-......_.�..[vt..G-a...-•--•--••-•---------------".-_ ---------------------------- Phone."C'SP1P. <br /> installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other S��Le�1L 1 <br /> Number of living units: ........ Number of bedrooms _..----- Number of baths ...... Lot size -..25_77 ........ .... <br /> Water Supply: Public system ❑ Community system ❑ Private Z Depth to Water Table . . . ft. <br /> Character of soil to a depth of 3 feet:1 Sand A Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay [IAdobe E] Hardpan [] <br /> �V <br /> Previous Application Made: (If yes,date........ ------ ----) No Q New.Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> y(No septic tank or cesspool-perrmitted if public sewer is available within 200 feet.) 9 <br /> Septic Tank: Distance from nearest well.................Distance from foundation____________________Materiel................................................ <br /> ❑jff-4S44AZ No. of compartments-------- --------------Size-------- ................---Liquid depth----------- -- ----------Capacity.................... <br /> If JI <br /> Disposal Field: Distance from nearest well .AAA--._".Distance from foundation..A/9P.__.__.Distance to nearest lot li e__/..QA_._.. <br /> Number of lines._¢__.-.. .1�. Length of each line_.._ Width of trench....3�P.._. <br /> ``t .,,�...__ � � p ! <br /> Type of filter materiel F. .. ..Depth of filter material.__..!"T_- length_..........QQ--------.........f <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 nearest well."...............Distance from foundation...................Lining materiel . . ---------__________•-.._-. { <br /> ❑ Size: Diameter..... .......... ............... .Depth....---.......... ...............................Liquid Capacity..........................-.gals. <br /> 1 .Distance from nearest building Privy: Distance from nearest well.................................. ..._._._._ g-----------•--.. •._•.----••--•------ <br /> ❑ Distance to nearest lot line....................................... ....................__.-........ . . ............ ........ ---............... <br /> 0 <br /> Remodeling and/or repairin escri ( ):. ._ - �$ / yS " <br /> ._... <br /> .............................................. ........... ---------•- . . <br /> ............................. ................................................................ ........-•-••••-••---•••-•----..................................................-............................. ........... <br /> r <br /> 1 hereby certif ave prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State I ws, and ru s��ppand[regulafions of the San(Joaquin Local Health District. <br /> ...�_..LI... t_V �-�..'.. .. (Owner and/or Contractor) <br /> (Signed)-------.--•-- <br /> By..••---•-:-••---_•= C�f�!L4!S.X ... &1A. t hA --------_----------- (Title)....... <br /> (Plot plan, showing size of lot, Iticefion R system in relation"to wells; buildings etc.,carP"6ei bce -reverse-side).::FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----------------------------------------- ---------------..... I_L DATE- <br /> a ,. <br /> REVIEWEDBY----------------- ------------------------•------------------------•-....... ....--........-------- •---•----•---._ DATE. -----•----------•----------- <br /> BUILDINGPERMIT ISSUED--------------I---------------------- ..................._..... ............................. DATE.....-•-----------_---•------- ------------------ -- <br /> Alterationsand/or recommendations:�....................................... ........................._.............................-•.----•---•.......................................... <br /> . ................................ ......•----" .................................................... .............................--....._............... <br /> ..... <br /> ...................... ---------•-••........................................................................................:....................... <br /> ...................... ..•• -------- •--•------•-.........------...._.........•--•••-----•----•--- •---....._...----------•-.............-----_... . <br /> ..............------•------ ------- -- - • { <br /> i <br /> ------ . •--------------- ............................................. <br /> FINAL INSPEC ION B Ji <br /> Do - 1.__.:..Z `-h- ...................... 1 <br /> SAN JOAQUIN LOCAUHEALTH DISTRICT <br /> 16o1 E.Naselion Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> stecitten,California Lodi,California Manteca,California Tracy,California <br /> r.a.cc. !I <br />