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FOR OFFICE USE!, <br /> ------------------ ---- --------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. �,? 07 90 <br /> .................... <br /> ----------------------- ......... ... ------------------- <br /> - --- --------------------------- <br /> -----------------­---- (Complete in Duplicate) Date Issued <br /> ------------------------------ ---- ---I ------------- This Permit Expires I Year From Date Issued - ------------------- <br /> Application is hereby made to the San Joaquin'TLocal Heal+h District for a pe mit to construct and install the work herein described.. <br /> This application is made in compliance with Counfy�iO.rclinance No. 549. /f <br /> "vni all <br /> JOB ADDRESS AN LOCATION�, MiR-.m"i 1------------------------ <br /> _704 <br /> 10 <br /> Owner's Name------- - ------ ----------------- ------ ---------------------- Phone-------------------------- -------- <br /> Address - ------------------------- ----- -5- ----------------------?ZZ ------ --------e� Phone..--•-••----------------I---- <br /> Installation <br /> ------------- ------­- <br /> A--------------------- <br /> Contractor's Name----------- 45a-2------ 4L-------- --------------------------- ------ Phone--------------------------------- <br /> Installation will serve: Residences© 'Apartment House)[] Commercial ❑ Trailer Court E] Motel [I Other <br /> Number of livjn its: Number of bedrooms :-Number o -baths -- --- <br /> Lot size -- ------- ---------- <br /> -- <br /> Water Supply: Publ c. sysfern Private Depth-to Wafer Table .------- ft. <br /> ITY . Community s 'a <br /> & 71_—er C em Prva <br /> pp� A`m <br /> Character of soil to 75 depf h_iof 3 feet: Sand �ecGravel [] Sandy Loam E] - Clay.Loam E] Clay E] 'Adobe C] 11 Hydpan 0 <br /> Previous Application Made:rilf-yes-,date-- -________________J No ❑ New Construction: Yes 0 `No El FHA/VA: Yels El No El <br /> =TYPE OF INSTALLAT16N'ANb SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well_________________Distance from foundation----------------....Material----------- -I_----------------------------- <br /> ❑ No. of compartments--------------------------Size--------------------------------Liquid depth-------------------------CapaEjfy--- -------------- <br /> Dis Field: Distance from nearest well----:��-----Distance from foundation----eO�---------- Distance to ne�iresVlot line____57__'r..... <br /> - ---------- - -------------------------- <br /> piz Number of lines___-__.-____)_-___...-- Length of each line_________ ---- Width of french_____'3- <br /> -------------------------- <br /> Type of filter material-------- --------Depth of filter material------P'7_ Total length ......s/ ---- <br /> Seepage Pit: Distance to nearest well-----------------------Distance,from foundation-------------------Distanceilto nearest lot line--,-______.___.._ <br /> El Number of pits-------------------__Lining materia}_,_-------------------Size: Diameter--------- Depth-- ---------------------------- <br /> V-6.0-4w -4 <br /> Cesspool: Distance from nearest JOL---------- -----Distance from foundation------------------ -Lining malarial-------11!------------------------------ <br /> El Size: Diameter------------------ __Depth---------r----- ------------------------------------Licluid,,Capacity_,�t------------------------gals. <br /> 11 .01 �r <br /> Privy: Distance from nearest well-----------------------------------------------Distance from nearest building--- ---------------------------- -- <br /> ❑ Distance to nearest let line- . _--------------------------------- ----------------------------------------------------------------------------------------------------- <br /> ------- ----------- -------------- -------­­---------------------------- <br /> Remodeling and/or repairing (descr;be):--------------------------- ---------------- <br /> -------- ---- -----------i---------- ----------------------- <br /> ---------------- --- ------------------------------------------ -------- ------- ---- --- -- -- 4'.P -- <br /> ------------------------------------------------------------------- ----------------------------------------------- -----------------------------------------------------------------------------------__ <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------;'o ----------------------------------- <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)---------- -------------------- ---- --------- ------- - - ------- ------------ ------------------------------------------------- ----- <br /> ---- ------- - ------ -----i6mlrp and/or Contractor) <br /> ----- --- --------------------------------- <br /> _�a <br /> ----------- ----- ----- --------------------- ------------ <br /> By:----- ------------- -----------r----•"._.-- �t _-`- <br /> (Plot plan, showing size of lot, location of system i relation to Wells buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --------- ---------------•------------------------ DATE-- h G ------------------------ <br /> REVIEWEDBY---- ----------------------------------------------------------------------------------------------------------------------- DATE----- ---------------------------------- <br /> BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------- ----------------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:-------------- ------- ------ - ------------------------------------------------- -------------------------- ------ -------------------------L----------------- <br /> --------------- ---------------------------------- ---------------------------------------------------- -------------------------------------------------------------------------------------------------------------- <br /> ------------------------ ----------------------------------- ---- --- -- -------------------------------------------------- ----------------------------------------------------------------------------------------------- <br /> ------ -------------- ------------------------------------------------------------------- ----------------------------------------------------------------------------- ----------------------------------------------------- <br /> --------------------------------------------------------- -------------------------- ------------------------- ---------------------- - -------------------------------- --------- ------------ ---------- <br /> ----- -------- <br /> FINAL INSPECTION ----- <br /> D ------ -------------------------------------- <br /> ------------- ate-- -------- ------------ <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 />