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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT-{--- Perrr t No. -.147 .3./ - <br /> s (Complete in Duplicate) lc r c� <br /> Date Issued .__�71sr <br /> -- --µ _________ _________ _____________ "R This Perin; Ex if;s 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 in compliance with County Ordinance No. 549. <br /> `` /-----------------------ter.c-c J C Qi°� �- -------------------------- <br /> JOB ADDRESS AND LOCATION----�[�l-- ------���- ------�°`' - ------•------•----- ---�•-- �I <br /> Owner's Name C�`,-,—'-`--!-tJZ---•---f�-_ = �f' =-------------------------- --- - ------------------------- --- -- Phone s� .3�`1 <br /> Address--------- `r-x = "' " <br /> ---- �a --f------------------- <br /> Contractor's Name---------- <br /> -----------------2 Phone f <br /> Installation will serve: Residence f& Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _- ._-_- Number of bedrooms Number of baths _ __.._ Lot size .___-� -� <br /> g J / (2.. .. �t�y----- <br /> Water Supply: Public system ❑ Community system ❑ Private 0 Depth to Water Table —T ft. <br /> Character of soil to a depth of 3 feet: SandK Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: {1f yes,date---_).,--------1 No ❑ New Construction: Yes ❑ No ❑ 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.) eSeptic Tank: Distance from nearest well---:'�_v-------Distance from foundation__l�-----------.Mat tial----.___..______._.._-____.___._.------- <br /> ____. <br /> No. of compartments------2-----------------Size---_?-?E_ x------..:_--Liquid depth--------- --.-_.,.---Capacity---- ----U-------- <br /> Disposal Field: Distance from nearest well...sv_._._Distance from foundation---e___--------Distance to nearest lot line__'a------------ 4 <br /> Number of lines-__ Length of each line______i a°__ ____._____r-Width of french---^ _�_a.3._r-------------- is <br /> Type of filter material___��e_��.___-- _._Depth of filter material-.�-q(_k'N Total <br /> -----------------•- <br /> Seepage Pit: Distance fo nearest well------ ------- -------Distance from foundation....................Distance to nearest lot line.._--_----_-__-_ <br /> ❑ Number of pits----------------- -M1Lining material.................._....Size: Diameter---_----_--------------Depth--- __.__.---------------- <br /> - ---•� ^ <br /> O <br /> Cesspool:. Distance from nearest well_- ............_Distance from foundation....................Lining material---_---------_-------------__-------_. <br /> ❑ Size: Diameter------------------ ---------------Depth-------------------------------------- ------------Liquid Capacity----------------------------gals. <br /> It <br /> Privy: Distance from nearest well------------------ --------------------.----._.Distance from nearest building----------._-----------------.----.------. <br /> ❑ Disfance to nearest lot line -------" ---- - -- ---- ------- ----------------------------------------------------------------------------- <br /> Remodel f <br /> -,- , <br /> ing and/or {desciilJe�: - ----- --------- ----•---••------------------------------ <br /> - ----- ------ ---- <br /> 3 ' '`' G AcG� ` t� - - ,nom=- ---.2- G�-``�------�---------------------- ---- - - --- <br /> =Ag_�-=�_- �- '` r6"�- -------------- ----------------- =------------------------------------------------....... <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 r "' <br /> �'��-:-=----A--: - - --- - -- ---�;_._ - - - -------------------------- ---- -- -- ------------------Owner and/or Contractor <br /> t :. 1 <br /> B . ----------•--------"------- ----------------- ------ - -- --------------------- Ti+le <br /> (Plot plan, showing size of lot, location of system in relation tolls, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- 7t --------------- ---------------------------------------- DATE S-(O-mss <br /> REVIEWEDBY--------------------------_----------------- -------------------------M- -------- -•---------------------------------------- DATE_....---------- ------------------------------------ <br /> BUILDING PERMIT ISSUED------------------------------------------- ---------------------m------------m----------------_ DATE.. <br /> Alterations and/or recommendations:. �' `(P i�. 2 ,.! _� CtiG L, - ------------------------------------- -� <br /> ---------- -- -----------------M------------------------------------ <br /> ------------------------------ ------------------- --------- ---------------- ------------------­------------------------ -------- - - -------- ------- --------------------- <br /> FINAL <br /> --- -------- <br /> FINAL INSPECTION BY:- Date ---- �0 1 <br /> SAN <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> 1641 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Slocklon,California Lodi, California Manteca,California Tracy,California <br />