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—FOR OFFICE USE:-I <br /> ------------------ --------------- --------------------- o - --a <br /> ------ APPLICATION FOR SANITATION PERMIT Permit No. <br /> :- ; (�' �plete in Duplicate} Date Issued— <br /> O— <br /> ssued <br /> ( —' <br /> — .� � __ This Permit [ztilires 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 compliange with County Or� ante No. 549:Q� ISH ; <br /> yJNiO / 'Y''eX c <br /> JOB ADDRESS AND OCATI�O,N-- `3 ---�--- __-_:_ ll�� � . <br /> Owner's Name .: z= --- <br /> Phone--------------------------•-------- <br /> Address.- - ` �C� � --------- � -;-----..--7---�'--�j.c7f•� --------------------------------------------- <br /> Contractor's Name------D_e /!i -- - � r�Oe}ri� -------------------------- <br /> R <br /> --------•-------. Phone <br /> D,_411 <br /> Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑,�jMotel ❑ Other ❑ <br /> Number of living units: -1---- Number of bedrooms,?-.--- Number of baths -_,e,- Lot size ./_".._��.+�'i�ro �e:'-­----------------------- <br /> Water <br /> -----------------------Water Supply: Public system ❑ Com1Wity system ❑ Private Depth to Water TableX5 ft. <br /> Character of soil to a depth of 3 feet: Sand [Gravel ElSandy Loam ❑ Clay Loam El Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date_____________ No E�` New Construction: Yes ❑ No [�]-' FICA/VA: Yes ❑ No E�, <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 nea�est'wei—..-- --Distance-from oundafiion_ .Material -'-�-'"'•'� <br /> ------- <br /> ❑ LTJ(IST/�/v No. of compartments-. ---------- - --Size-------------------- •--' Liquid depth Capacity _ <br /> -------- - <br /> Disposal ield: Distance from nearest we€i---sV._..._Distance from foundation_._ ----------Distance to nearest lot line --------------- <br /> Number of lines--- ----------------------Length of each line__f_pw__ ____........ <br /> Width of trench__-_-- , :______.________-.- V. <br /> Type of filter material: �4_ert4_4'.__-Depth of filter material1 ----___-.-_dotal length__.-fes!?_-f____________________ <br /> Seepage Pit: Distance to nearest well _____________-------Distance from foundation--------------------Distance to nearest lot line_____..____-___ <br /> ❑ Number of pits----------------------Lining material---------------:------.Size: Diameter-- .------------. --Depth---------___------- ----- .O <br /> Cesspool: Distance from nearest well----------------- from foundation---------------------Lining material---------------------- _______._____-- <br /> �] Size: Diameter--------------------- <br /> ---- -----Dept - <br /> r <br /> - 3 <br /> I <br /> � ------ -------------------------Liquid CapacitY--------------------•------gals. <br /> Privy: _...__.__--___-. --Distance from eb -- ---------- ---------------- ----------ttfroneareswe _____..._______--------___ <br /> ❑ 1 Distance to nearest lot line ------------ ------------------------------ �-----------------------------------------------•-----•=------------- . <br /> s DI moi. ------------- <br /> Remodeling and/or repairing [describe :___: --------------Q-----�-�-�----- � -- --`'---------- �--------- -� <br /> _ _.. <br /> --- <br /> ----------------------------) --- -- <br /> ---•----------_.---- -------------------- --- <br /> ------------------------------------------•-•----•---------------------------------------•------------------- <br /> .1 <br /> ----------------------------------------------------------------------------------------------------------------------------- --------------------------- ---------- ------------ <br /> 1 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 S- Zxan JoLocalLocal,Health District. <br /> l Qi '. ___, <_ aw <br /> and/or Contractor) <br /> (Signed}-----�g- - r.._ - ---- r <br /> gy.- --- ---- -----------------------------------------{Title} <br /> {Plo -plan,_showing.size:oUlot,_location- ._system-in-relation fo-wells,.buildings, efc., can-beplaced on-reverse side}. <br /> p FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- ----------------------- � <br /> ---- ----------------------------------------------- DATE--------- - --Qp <br /> -74�---------- ------------- <br /> REVIEWEDBY------------------------------------------ ----------------------------------------------------------- DATE - <br /> BUILDINGPERMIT ISSUED-------------------------------------- --------------------------------------------------- --------- DATE-------------------------------------- -----.------- <br /> Alterations and/or. recommendations--------------= - --------------- _ ------------------------------------------------;--------------------------------------------- ........ <br /> ---- '=----------- <br /> FINAL INSPEC Date----- <br /> - - - ---- - - ---- --- - - -- - <br /> --------- _-_I� p ------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazollon Ave. -300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton;,California Lodi,California Manteca,California Tracy,California <br /> •. F.P.CC. - <br /> , <br /> , <br />