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FOR OFFICE USE: <br /> ----- f _. ....---- - -- - -- -------- r <br /> APPLICATION FOR SANITATION PERMIT Permit No. .- I.. <br /> ..------Y, -------------- ------- (Complete-in Duplicate) ,/ <br /> .............. This Permit Expires 1 Year From Date Issued <br /> Date Issued ..tib-/..` `�Pd <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 LOCATION.__�_ -.::m_:.. . _ _ <br /> Owner's Name.---L541(-�}-•---- ----------------­------ -... .. ................... <br /> --....... ..... Phone--.-. <br /> ------------------------•---- <br /> � ......................................... <br /> �j Address-:. --- ------------------------------------- - - -------- <br /> ..._Contracter's Name-- l <br /> ....... Phone-7 1.- �b ----- <br /> Installation will serve: Residence <br /> X, Apartment House ❑ Commercial ❑ Trailer"Court ❑ Motel ❑ Other ❑+ " <br /> Number of living units: .!.. Number of bedrooms --oot Number of baths----/ Lot size _._ �d <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table __,___ _ ft <br /> Character of soil to a depth of 3 feetF• Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay p Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,clate_ y - ) ,No ❑ New Construction: Yes ❑ _No ❑ FHA/VA:..Yes No.E:] <br /> TYPE OF INSTALLATION AN5 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------------------ .............................. \ <br /> ❑ No. of compartments ............Size----------------------- ----Liquid d�depth...- -. ....._ ..__. Capacity--------_-�----- <br /> �tt <br /> Disposal Field: . Distance from nearest well... <br /> S�. -.. Distance from fou`ndatio�/n�...� ..........Distance to nearest lot <br /> Number of lines r..__.f .....-Length of each line _'7r _..._f�__---.Width of trench._. <br /> Type of filter.matorial/ _ epth of filter material �� _... . Total length_... <br /> of <br /> Seepage Pit: Distance io nearest well:...-..... .. ......Distance from foundation-------------------Distance to nearest lot line.._______.__._.._ <br /> ❑ Number of pits.........._...........Linin material.................... Size: Di t Depth <br /> Distance from no r s w Distance foundation ...Lining material <br /> Size: Diameter_ Depth .............................. ..Liquid Capacity. ............ .............gals. <br /> Privy: Distance from nearest well...................... _... _-.... ..... ._Distance from nearest building---------........_.._._._--- <br /> ❑ Distance to nearest lot line.................... ............................... ... ......_..._. .. - <br /> iRemodeling and/or repairing (describe: GA��[% t�' e� ---� - �.`P, ----- XW < <br /> l <br /> .....................-...... -- -- .......................................... .........................................I.......... <br /> ........ t <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 /> wy�,.(Signed)_.. .»:� !•,�:-:... 7— __ -- :.._... (Owner-end/or=Zontrac€t;:,j�- <br /> r ,.. <br /> IBy:.----E- -- ---- -.-- --- ------------------------------------_--.------(Title)------ -------- --------_--------.----... -----------.---- <br /> (Plot plan, showing size of lot, location of s tem in relation to welts, buildings, etc., can be placed on reverse side). <br /> ( FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY........ - Tv.. -=-•---•-•-------- -------------- DATE.'.._.. .......... <br /> REVIEWEDBY........ -------------- i---•- - -- - -'---.. ....... --...--•--------..._ ........... DA-(E--- - ------ --------------------------------- <br /> 1 BUILDING PERMIT ISSUED.------. ----------- -- ----•....... ..........------------.-------------------------------------4DATE.....------.--- -•------------•-•--•-------. ........... <br /> t Alterations and/or recommendationsi............................- - ..... -- -- -•---•--•-----•---•------•--•-----�--.---...-..-------------•-------•------------------- - ' <br /> I <br /> ( ............. ........ . . ... .. ................... . •. -•------ -----A&. <br /> --....._--- ----------------------------------------------- - - ....... .-_ .. ........ <br /> ------------------------ •-• ............ --•-•-......_.... _..-------- .--- ................ <br /> r. <br /> FINAL INSP Date_.....__.. ... ...._..`.... -- ---_------------------------- <br /> SAN <br /> ------ -- - ------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Na:olten Ave. ' 300 West Oak Street 124 Sycamore Street 20S West 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> j1j� E.H.9 7M 1.67 Nanguord Press <br />