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rVK vrrlc,t USE: 7 <br /> ..................................... <br /> ................................................ ........ APPLICATION FOR SANITATION PERMIT Permit No. <br /> ........................................ ................ (Complete in Duplicate) <br /> Date Issued <br /> _ _ This Permit Expires 1 Year From Date Issued . o.!_ .. <br /> "Q_.j3- ZfO-[6r' <br /> Application is hereby,made to the San Joaquin Local Health District for a permit to construct and install fjtCwork herein desen' d. <br /> _This_application,is,made.in.compliance with County Ordinance No. 544. ( r <br /> JOB ADDRESS AND LOCATION.tJ�,ft�� <br /> Owner's Name.... -----------_`-:----•-•------- ------... Phone............ ....•---•............ <br /> / f <br /> Address �' .: � .-----•!'rQ 1 !Jt" lJi� .:....../ ,�' ..... <br /> Contractor's Name.:.._. 11 - y I ... Phone................ <br /> 1 0-= � � ..... ...... <br /> ------------ <br /> Installation will serve: Reside ��R artmenf House [] Co�mercialailer Court ❑ l%tel ❑ Other ❑ <br /> Number'of livingunits!*'^"..2 mber of�,bedrZSoms ?�- Number of.baths . _dA-- Lot size . . <br /> ,� ��.f"�_tea..._..-.._............... I <br /> Water Supplyi Public system Q Comm itr�system ❑ Private epth to Water Table .- :t. <br /> Character of soil to a depth',tof 3-feet: Sand ❑ Gravel *_"�andy Loam❑ Clay Loam Clay 0 Adobe❑ Hardpan❑ <br /> Previous Application Made: �(If/�e'i,dd........ ..........I No { New Construction: Yes [LI/No ❑ FHA/VA: Yes ❑ No Ej - <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._ew_.Distance from foundation___e;V`,.0........Mate ial/f'....... " ........... ^W <br /> No, of compartm'-ents_;� ..._._.. _.Size' �Q., �' uid depth.. A-- <br /> /.........._Capacity �,Gr <br /> Disposal Field: Distance from nearest we1lXe......Distance from foundation__�a_�...._....Distance to nearest lot line-- ---__--- <br /> [�� Number of lines:f �_Vi� cepfh <br /> ` en th of each line___.�.._ __`..... ...WicJth of trench. 2_-l <br /> ................------••-- <br /> Type rf fiiter maeZ.e._ of filter material....I-ell .._-.._-..Total length--cto.7...................... <br /> Seepage Pit: Distance to nearest ell__ 1�".._-_.Distance fr fo dation.l'U _..__..Distanca to parest]of lin_f.." <br /> 2j Number of pits.. ........... material.. 9Q .Size: Diemeter. Depth../ :t!.1 <br /> Cesspool: Distance from nearest well.......:.........Distance from foundation-.................. Lining material-------............................... <br /> ❑ _ ., j y ...............Depth...............................................-....Liquid Capacity............................gals. <br /> Size: �ameter..................... <br /> Privy: Distance .rom nearest well................ .............................. .Dista.nce from reares. building........................................... <br /> ❑ Distaincwto nearest lot line.............................. ............. ......................................-•-----...-------------..._•---..I...........•.... • <br /> .. .`�✓• c_ <br /> ._....Remodeing and/or repairing 3describe):_ ------- ------------ ......... <br /> .............................................. •--•--------------•----•-•-------- <br /> M <br /> .. <br /> ................••-...................1•--------- -----------------• ": --------� <br /> } .. - _ - ----------•-------- - '_: <br /> 1 I hereby certify that-I Ihavo prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State iawstand:tsand(regulations of the San Joaquin Local Health District. <br /> ......�r Contractor] d <br /> 1 By: j - ( ) ............ ................ <br /> -...'.t " " Title <br /> (Plot plan, showing size!of lot, location of syste re ation to wells, buildings, eta, can be placed on reverse fide). <br /> DEPARTMENT USE ONLY ! , <br /> APPLICATION ACCEPTED BY........yp,_. .. Q .. --_--------------------- DATE._.. ._�. .d=:-6.. . ......... <br /> -......... .� <br /> REVIEWEDBY........................................*......................... -------------­------.................... -••--------• - DATE ...---................._.._.__................. ; <br /> BUILDINGPERMIT ISSUED..................°:_........._.___....._. . DATE..(.__....-•-......_...-...._..._..._....._.....I...__....... <br /> _..... <br /> Alterations grid/or recommendations:...............................-......_:..... .................... ...... ............... j_...................*............ . <br /> s <br /> -----------I.................................----...............-.............................-........................................... 1................... •--1..............--------•--•--•-- <br /> ........................................ <br /> .............. ..............................................._..........t._........ _ ............................ <br /> `i <br /> ............ .........------•-•--•- ......._..... .......... ,,r <br /> _....-....... . ._...... <br /> FINAL <br /> INSPECTION BY:...,.a� .`__.�%(O Date........._..1...- .:r.. .. _....... <br /> ��---.....-•- fes................................. <br /> { SAN JOAQUIN LOCAL HEALTH DISTRICT i <br /> p <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 1 205 West 9th Street <br /> Stockton,California Lodi,California '} 1 maniacs;California .�1 Tracy,California <br /> P.P.Ca. <br /> I <br />