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-:OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT Permit No. ------a...... s. <br /> ------- - --- '` ,_ ---------- - (Complete-in Duplicate( <br /> Date Issued <br /> __-__._..._.._. l This Permit Expires_I-_Year From Date Issued <br /> -. - - -- <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein des`tribed.` . <br /> This application is made in compliance with County Ordinance No. 549. <br /> tJJ - ----------------------•---------------------------- <br /> JOB ADDRESS AN LOCATION'___s�_�.__1�_r�__._ _-� _______-..�C`-r--------- - <br /> �f -- - Phone-------------------------- <br /> Owner's Name-- !c`�s'"s.o�.� :✓ ----------------------------------- <br /> Addressorr pp -- -----------------------------------•------------••------••------------------ <br /> Contractor's Name------C_11 r--------- ----` �- -- - --- r r+ Phone , rte <br /> Installation will serve: Residence Apartment oto use E] Commercial E] Trailer Court ❑ Motel C] Other ❑ <br /> Number of living units: __f-- Number of bedrooms -.1-- Number of baths__/._ Lot size __A5577 k-- ------------------------ <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ------ _ ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Ex Hardpan ❑ <br /> Previous Application Made: (If yes,date-----------,------- ) No A. New Construction: Yes ❑ NoK FHA/VA: Yes ❑ No X <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-_ --_Distance from foundation------------------_.Material --------------.._-_____...._____------.J---f__- <br /> ❑ fx No, of compartments_.._..--- ---------------Size------------- ------ ----------Liquid depth--------- ------ --------Capacity--------------------- <br /> Disposal Field: Distance from nearest well......... .......Distance from foundation--------------------Distance to nearest lot line___--_--_-_____._ <br /> ❑ rv,,4,; Number of lines ----------------------------------Length of each line--_--------------------------.Width of trench.-------------------------------.-- <br /> 7 Type of fitter material.- ------ - ------ ------Depth of filter material--------___------ Total length------------------------------------------ <br /> Seepage Pit: Distance to nearest well-------------- -------Distance from foundation---------.---------.Distance to nearest lot line---------_.....__ <br /> ❑ Number of pits--- ----------_---Lining material-----_---------------- Size: Diameter----------------- -----Deptn_...----------------------------- <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 to nearest lot line------------------------------------------------------------------------------ IN <br /> Remodeling and/or repairin (describe):----- __ - __ ___�_____ .__ i .-a-._..-,. ice —_____________ <br /> A26----------- ----- -------------- T'- ------ <br /> ----------------------------------------- ----------- - -- <br /> ------------------------------------ <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)--------- ------ --�--------- ---- - I --- -------- --- -------- --- - - - - ------- ---------------------....---- �- - - --------(Owner and/or Contractor) <br /> By:--------C + , ±-'^1 (Title) f <br /> (Plot plan, showing size of I , locatio of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> t <br /> DEPARTMENT USE ONLY <br /> f <br /> APPLICATION ACCEPTED BY.-----1-- -------- -------- --------------------- -------------- -------- - DATE- --------------- <br /> REVIEWED <br /> r --------REVIEWED BY----- ------- ------------ ------ DATE---------------------------------- <br /> BUILDING PERMIT ISSUED-------- -------------------- --- DATE--- ------- <br /> Altere#io and/or recommends ions:._------- fU-Ff -�� u�` f- !i� <br /> f ( ----------- <br /> --- R f <br /> r------------ - -- <br /> --------------------------------------- ---- -- - ------- -- ------ --------- ------------------- ---- - -- ---- ---­-------------------------- ------ --------- ------ -•--- -------------- <br /> � <br /> FINAL INSPECTION BY:.----- . . - Date-- { ` - --------- <br /> N AQIJJ LOCAL HEALTH DISTRICT <br /> 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockfon,California Lodi. California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 vanguard Press <br /> �ff� � <br />