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FOR OFFICE USE: II _ <br /> .I <br /> _--------------------'I----_ APPLICATION FOR -SANITATION PERMIT Permit No. .1�. '__ <br /> ---- ------�----- (Complete in Duplicate) <br /> --------------------------------------- <br /> ----------- ----------------------- -------- <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 /> OwBneAsnNamSe _AND LOC _ <br /> --------------------------------------------------- <br /> RR <br /> - S <br /> ------A p 1 --------0I.A. ----------- <br /> ---------------------------------- <br /> Address <br /> Ph e._ <br /> Address--------------------------- �` <br /> t =r RG ---------------------------------- <br /> Contractor's Name----------- iI-------- ------------•-------------------- ----------------------- ... --------- Phone--------------------------------- <br /> Installation <br /> ----- -------------------------Installation will serve: Residence` Q Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __(.__. Number of bedrooms _t�__ Number of baths ___J{___ Lot"size _____________���-�__-____..__________________._._ <br /> T W)AER Far? hN/+rartre <br /> Water Supply: Public system ❑ Community system ❑ Privateer Depth to Water Table _ eft. 5 <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------..............) No E�- New Construction: Yes Ee *N�'o ❑ 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 Tank: Distance from nearest welL__Is-Q------Distance from foundation-----[0----_... Mate:rkc,l___lp1 Cgs_ ________________________ <br /> No. ofd;compartments---------- ----- ------Size-----I *-.(±A-'/-----.Liquid depth__--_-'y.:i.---------Capacity__-J.2-------- <br /> Disposal Field: Distance from nearest well_ _: ______Distance from.foundation'_-412----------Distance to nearest lot line---•a_-------- <br /> -A <br /> Ql Numebor of lines------'____ta ____. __-Length'of each Irn`e'_3 '� � _-_.Width of trench---------v� �__ - __ <br /> 6\ <br /> i _ Dept of filter material----- Total length---------- -- -------------------- <br /> Seepage Pit: Ditance to nearest well______________' ^ <br /> f filter material <br /> � _____---Distance from foundation----------------____Distance to nearest lot line__----_-__.-___- Q <br /> ❑ Number of pits___-.___.._...__..__Lining material________________ p ` <br /> ,y ---•---Size: Diameter--------- - ------ --- Dept - -- -- ---•••---------------- � <br /> Cesspool: Distance from nearest well----------------Distance from foundation--------------_____.Lining material___--____________.___.____- <br /> ❑ Size: Q,iameter--....- --------------------- -----Depth- ---------------------Liquid Capacity. ._----- -----_- gals. <br /> Privy: Distance from nearest well---. ---------------------------_____---._Distance from nearest building__ <br /> ❑ Distance to-nearest lot line-----------------------------------•----------------------------------------------------------------------------------------------•----- <br /> Remodeling and/or repairing (describe :------- - ----------- -------------•----------------------------------------- <br /> u <br /> n-- <br /> II <br /> ---------------------------------- --------------•-----------------...--------------------------------------------------------------------------------------------------------------------------------------------- <br /> .1i. <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 /> (Signed)----!�'ff lX II---.- ---------------------- --- --(Owner and/or Contractor) <br /> By:----------------------------,'-------------------------------------------------------/------------------------------------------(Title)------------------- -------- - ------------------ -._...--------- <br /> (Plot plan, showing size of lot, location of system in relati to wells, buildings, etc., can be placed on reverse side). <br /> FO DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED - ---------------------------------------------------------------- DATE-------- - S----------------------------- <br /> REVIEWEDBY---- - ------- -----'------- --------- ------------------------------------------ DATE--------- ---- ---------------------------- ------- <br /> BUILDING PERMIT I UED --------------- ----------------------------------------------- ---------------------------------- DATE_------------------------ - <br /> - ------------------ <br /> Alterations and/or r endations----------------------------------------------_----------------------------------- -------------•----•--------------------------------------•--------•------- <br /> ij <br /> ---------------------------------- ------------------------------ --------...... -------------------- --------- ------------•-------- -------------------------- <br /> ---------- ---------------------------------- <br /> ---------- <br /> ------------------- ---- <br /> ---------- --=------------------------------------ ---------------------- ----------•------------------------------------- <br /> FINAL INSPECTION ---- Date---------/R��s --�--- ------- <br /> AN AQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.liaselton Ave:' 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> II Tracy,California Lodi,California Manteca, California Trac <br /> Stockton,California f <br /> !'F.P.0 C. <br />