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•k -FCROFFICE USE: <br /> ------------------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. . 7 �a <br /> ------------- - (Complete in Duplicate) <br /> ------- -------------------------- --- Expires <br /> ----------�=-- This Permit Ex fires 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 /> JOB ADDRESS AND LOCATION•__ -Q--F/------_- C�, , <br /> - --------- <br /> Owner's Name---' .I l <br /> -y,,,i1 ------.- -----------------------&A. �1 - " .-1-)Phone-------------- <br /> ,-� D� _ -----------•----------------•--------------••---------------•------- .........--------------------------- <br /> Contractor's Name.-L--- ------ ...... 's. --------- <br /> ------------ --- ---------------- ------- - -- ----•- --.- Phone----•---•---••---------•----------• <br /> Installation will serve: Residence 0'Apartment House ❑ Commercial ❑ Trailer Court I] Motel ❑ Other ❑ <br /> Number of.-living units: -1----- of bedrooms _-3_ Number of baths ---- Lot Lot size _-- :_----____ <br /> -------------- <br /> Water Su 4I Public.system PP Y� f y [Community system ❑ Private ❑ Depth to Water Table-_0667i.� . <br /> Character of soil to a depth of 3 feet: Sand i <br /> P Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes',date.____-�..._---__._) iNo gR`­New-Construction: Yes q?-'Mo ❑ SHA/VA: Yes ❑ No <br /> W. <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: : <br /> (No septic tank or cesspool permitted if public sewer is available within 240 feet.) <br /> Septic Tank: Distance from nearest well -- Distance from foundation-:-dIf ----.Ma#anal_-.�__-._. _._ <br /> ,. <br /> No. of�c'om artments-=__. ..__Capacity.._/_2_o__Q_ <br /> Disposal Disfanc ------- <br /> Number from <br /> r m near t well: - Distance from foundation._,�4.-_ _' ,�7- <br /> `��--�---- -.-.-.Distance to nearest lot line----------------- <br /> - ------------------------Length of each line_jcd�?'S�`- dth of french.___ ---------------------- <br /> Type <br /> of filter mat arof <br /> ia�a.C._,t---- Depfh of filter material--,L-&---_----._ g <br /> Total length _ _ <br /> Seepage Pit: Distance to nearest well--- ---.---Distance from foundation-__--IV------.Distance to nearest lot line------ -___-.. <br /> Number of pits___ --------------Lining material__F --Size: Diarrieter2.X -------Dept <br /> Cesspool: Distance from nearest well-----------------Distanc"e from foundation------------------- material--._-_---.--.-------_-------_------ <br /> ❑ Size: Diameter-------------------- -----------Depth-------------- -= ------.-Liquid Capacity--------------- gals. <br /> y * , k -------- <br /> Priv Distance'fr'6rn nearest well._* ____ ,:----.---------------------- 9 <br /> y' � .-.-.-Distance from nearest building_______--.-_------------- <br /> ❑ Distance to nearest lot line_,-------------------------------------------------------------------- - <br /> ----------- <br /> Remodeling <br /> ----- -Remodeling and/or repairing (describe):__---- ._ ----------_- <br /> ----••-•----••------------ <br /> -----•------------ ------•------------ <br /> t' <br /> --------------- -------------------- ---- <br /> I hereby certify that I have prepared this application and that he work will be done in accordance with San Joaquin County <br /> .ordinances, State laws, an rules.and regulations of the San Joaq Local Health District. <br /> T r ------------ <br /> 1 } ��W__ ----------- O�raer-and/or Contractor) <br /> {Signed 1 � ,..,. ,- -.-- �a { <br /> BY - - - r) <br /> ------------------------------------------------------ ---- Title __ <br /> )--------------------- -_ <br /> ------- --- <br /> ot plan, showing size of lot, .location'of system in relation to wells, buildings, etc., can be Placed on reverse side). <br /> '`' FOR-DEPARTMENT USE-ONLY <br /> APPLICATION,ACCEPTED..BY--.---L,..!_ -------- -- --------------------------------- <br /> ------ DATE-----REVIEWED BY l <br /> DATE ; <br /> -------------------------------------- ----------------------------------------------••------- . <br /> BUILDING PERMIT ISSUED ---- -------------------- DATE <br /> Alterations and/or recommendations:------- <br /> 0- - ----------------------------------------------------------- --------------------- ------------------------------ <br /> FINAL INSP BEf� Date - .. <br /> �~ w,SAN JOAQUIN LOCAL HEALTH DISTR CT� <br /> 1401 E.Hazelton Ave. 300 West Oak Street <br /> 124 Sycamore Street 205 West 91h Street _ <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> E5 9 REVISED R-59 3M 3-'63 F.P.Cp, �( <br />