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• gg <br /> APPLICATION FOR SANITATION PERMIT Permit No. .. �__1. . <br /> (Complete in Duplicate) <br /> 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. S49. 0-32__ <br /> JOB ADDRESS AND LOCATION_ \ �/q��- '-- -t <br /> Owner's Name-------- _/ ­b rr+e+,..=._._......,(J �, L!!!�!r.....e...... Phone-----------........................ <br /> Address - A .._... i :-.....-0 ..�"._.......... <br /> .........•.. .... ' - <br /> Contractor's Name _.....•...................................... Phone................................... <br /> Installation will serve: Residence/ Apartment House ❑ Commercial ❑ Trailer Court ❑ M�oteell►E,Other ❑ <br /> Number of living units: .!.... Number of bedrooms -3.. Number of baths -�ot size ..... <br /> .Ze_ --._______._ A------.............. <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table fid... ft. <br /> Character of soil to a depth of 3 feet: S; Ne. <br /> Gravel [j Sandy Loam 4 Clay Loam F-1Clay❑ Adobe❑ Hardpan C]E]Previous Application Made: Yes No Construction: Yes 2-;❑ FHA/VA:Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> {No septic tank or'cesspool permitted if pu6Vc sewer is available within 200 feet.) <br /> i <br /> Septic nk:• Distance from,narestwell.� �.•Distance,from•foun�,+ration._: '?r�+4MateriaL.:(-:�`7f� — t.__.:_.._:_= • <br /> Re No. of compartments..........2—----------- .......Liquid depth_._..!.................Capacity--- <br /> Disposal Field: Distance from nearest well__. Q.y_rv,_Qistance from foundation. <br /> ._ + .��.Y.r�.,�is+ante to nearest fol <br /> Number of lines...........'. . Length of each line.___.,��.................Width of <br /> Type of filter material... -_ _._ Depth of filter matenal.....Zr_._-.-.Total length......,1�4....................... N <br /> Seepage Pit: Distance to nearest well......................Distance from foundation...._-..............Distance to nearest lot line................. W <br /> ❑ Number of pits......................Lining material.......................Size: Diameter----------------- Depth-----.--------------------_---•-- ^1 <br /> Cesspool: Distance from nearest well.................Distance from foundation....................Lining material..__.............._................... <br /> ❑ Size: Diameter---------------------------------•-_Depth................................ -------__....Liquid Capacity............................gals. � <br /> Privy: Distance from nearest well-................................................Distance from nearest building-----------------------------.------------ <br /> Distance <br /> ._._._.__. <br /> ❑ Distance to nearest lot line............................................... .......................................................---------------............_--•--•• -- <br /> Remodeling and repairing Idescribe):...-----••--•-•-----•---...---•... .............•------........_... ---------•••. <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) ` .ries-T'........... .......... .. .. ---:_--.---.----.-.-..---.---.-----_-------------- -. ---_.Owner and/or Contractor <br /> By:.................................................-------- --------................................................................(Title).................................. ........ - ---- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed,on reverse side). <br /> t FO EFARTMEN JSE O LY <br /> APPLICATION ACCEPTED ........... ATE_-.--... .- - <br /> REVIEWEDBY....................-...................•---........--••--•-•-----... -•----•-•----------------------------------------------- DATE..................._---•-•--.............................. <br /> BUILDING PERMIT ISSUED-------------------------------------------------------------•---------------------------------•-- DATE............................................................ <br /> Alterations and/or recommendations........................... .._..__..._....._..._...............-._............................-•---------•-•-•-----.......-----•--------••--•--•--•-••----•••- <br /> •----••-----•..........................................••----••-•--....---•- --- •... ......_...._..•-----••----•-•--•----....------•--..................--•--••----•-•-•--••--•-••--••........--•--•......••--•---•-..---- <br /> ......................................_.............-•-••-••••-•-•••••------------•----•--•---•--..........-•-----•••--•-•........._._......_.......------.............-----._...•-•-•-•-•-•--•-•-•......---•-••........... <br /> -•-•-•.................•------••--•---•--•----•-•-•-•----••-•--......_._.._......._..------•--____..............._......---•••--•-•...._..-•--••---..........••.......--•-•-•--.....•-••-----............_...---••..---•-• <br /> --•-•-•--... •..... .. ........................ .. .......................... •-•--••-•-----...._...-•--•-•--••-•----•-•--•.......-•---....................••--•.._.._._ ------------- ------------------- <br /> FINAL INSPECTION BY:............4ke-11/1 <br /> "" .------•-------------- Date-------..-[.1..�._. ..-•�J <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-4 2M . Revisea 1-57 F.P.CO. <br />