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FOR OFFICE USE: k <br /> ----------------------- -------------------- <br /> APPLICATION FOM SANITATION PERMIT Permit No.�.4 :`z�- <br /> (Complete in Duplicate) <br /> Date issued 1%z .__r <br /> --------------------------------.-------------------- This Permit Expires 1 Year From 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-iry compliance with County Ordinance No. 549. <br /> JOB ADDRESS AN CATION Jj <br /> //�� ." - 4 -------------------------------------------••-------------------------------- <br /> Owner's NameC -' ------------ Phone..._.. <br /> ------------------ <br /> ------------- <br /> Address---------------------- e------------------------------ ----------------------------- <br /> V - <br /> Contractor's Name......... .......... ------------------------------ <br /> installation <br /> - `��y Y <br /> ------- -- - -- --•--• - -- ------•--------- -- ---- �-------------•-•--------------��---------•--•--- Phone.. ----------------- --------•-installation will serve: Residence [►Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number• of living units: .... Number of bedrooms .j_- Number of baths .. _ Lot size __ __� _.�_ =-`---------------------- <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Wafter Table •S�ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [❑ Clay Loam ❑ Clay ❑ Adobe [-Tardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No New Construction: Yes ❑ No P,- FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> tic nk: Distance from nearest well...... .........Distance from foundation------------.-------Material------------------------------------___-.---.. <br /> No. of compartments-------------------------Size-----------------:-------------Liquid depth---------------_-------Capacity-------------,-------- <br /> Dispos^al Field: Distance from nearest well.. !Distance from foundation...$. -_--.Distance to nearest lot line_--�... -4., <br /> L!Y Number of lines---------..-.- ...._-.-.-_Length of each line.- Q.�----.--�-----..Width of trench-.---- ,j��f--------------- <br /> - <br /> ............... <br /> Type of filter material'- - ----Depth offilter material___ __�...--------Total length----------- /Q <br /> Seepage P•t: Distance to nearest we -f ._Distance foundatian___�,? r____.-..Distan�e to nearest lot line.-h�-._._.. <br /> Number of pits......--------- .Lining material.. Q_4 ..Size: Diameter__3 3....-...._..Depth.------ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation...-----------------Lining material...-......-------.--.-.---..-.-------- <br /> y ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity-----------------------a----gals. <br /> Privy: ri Distance_frorn nearest w.ell_.=__-- - ___.__ oam neearest building.--.......__._______.._---------------- <br /> ..,�� ❑' � ` .x Distance to nearest lot line......... .------ -------- <br /> Remodeling and/or repairing (describe) �----------------------------------------------------------------------------------•------------------------------- •------------------ <br /> ' -------------•-----•------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------- <br /> -------------------------=--------------------------------------------------------------------•-------------------------------------------------------------------------- <br /> -------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------�------------------ I----------------------------- <br /> 1 I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, a laws and rules d r ulations of the San Joaquin Local Health District. <br /> rav <br /> (Signed)---- ----- - - ------ --------------=--- --- ------------ -----------ecedt <br /> (Owner and/or Contractor) <br /> By:. y.-�------------------(Title)-------- -- -----(Plot plan, showing size of lot, location of system in relation to wells uildings, etc., can be plreverse side). <br /> 1 <br /> I .. <br /> +, FOR DEPARTMENT USE ONLY 1 <br /> F APPLICATION ACCFPTEb BY ....%-- --- - ------ _ .� Q--------- DATE 1� l 6 <br /> REVIEWEDBY-----------------=---------------------- -------- -- - -- -----------tl------------------------------------------------------- DATE---------------------------------------------------------- <br /> BUILDING PERMIT ISSUED------- ;- ----- - /��a DATE-------------------------------------------------------- <br /> Alterations and/or recommendations:------ � 7- <br /> -------- /------ --- --------------------------•-•----------------------------------------------------------- <br /> ----------------------------------------------------------------- ----------------------------•-•-------------- --------------------------- <br /> . <br /> I =-•--------------- --------------------- ----------- -•-------------------------------- --------------------------------------------------------------------- ---- <br /> ( FINAL INSPECTION BY:-----./....'------ -=---------- Date ------ -------------------------------- ---- ----- - -----SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxelton Ave. I 300 West Oak Street 124 Sycamore Street 205 West 4th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> F.F.0 O. <br /> i <br />