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FOR OFFICE USE: <br /> &,' ---------------- - ---------:. <br /> .i,el7?__- APPLICATION FOR SANITATION PERMIT Permit No. <br /> --------------- --- ---------------- ------ (Complete in Duplicate) �c� <br /> Date Issued ______ <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 in compliance with County Ordinance No. 549. ?vd <br /> JOB ADDRESS AN LOCATION----—- Q,G......�`` -9-0 <br /> } ll =Iv--c { - - Phone------------------------------------ <br /> V­.Z1 Name--------- <br /> K)..'Iv <br /> 1 -_..._Ca ------------------------------ <br /> Address----------•---------------------- -- - - --- a-�------------�::-�-l�nS.---•--------�.. •------------=-------------•------- <br /> Contractor's Name-------\\Q T ---- - ---- <br /> !?__l Phone.. <br /> Installation will serve. Residence [�Apartme`nt House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ , <br /> Number of living units: ----L Number of-bedrooms _2_ Number of baths -f----- Lot size ____.. . �y---- E <br /> Water Supply: Public system Community system El Private ❑ Depth to Water Table -46-V . <br /> Character of soil to a depth of 3 feet: Sand [j Gravel ❑~ Sandy—Loam ❑ Clay.Loam ❑ Clay ❑ Adobe 53--Hardpan ❑ <br /> Previous Application Made: (if yes,date_..................1 No New Construction: Yes E0,,?4Q FHA/VA: Yes ❑ No j]— <br /> TYPE <br /> ] .TYPE OF INSTALLATION AND SPECIFICATIONS: a. #- .; <br /> r,is available within 200 feet.) <br /> T k: Distance from nearest well-___..�_--.Distance public from foundation_ --______ _. r�--------- -- <br /> _ Mat nal-(=.-+-� --- -------- C -------------- <br /> Septic <br /> No. of compartments.... ..................Si ---Liquid depth------ -2-•-------Capacity..{-!Q-- ------------ <br /> ---------- <br /> --f- -- <br /> Disposal ield': `Distance from nearest well_________________.Distance from foundation____ _ Distance to nearest lot line__-._._.. <br /> �_ I'-------- --- ---Length of each line------- <br /> .--.Width of french--- <br /> Nu`mber of. <br /> of fuer material_ I°' ltSbepth of filter matenal__..__ �'.l1__..Total length______/` `/ 5,;- ----_ <br /> Seepa it: DEstance to-.nearest well----."'_____.._----__Distance om foundatiioon"�_��_�__ ---------------- <br /> Distance to nearest lot li��`___------- G <br /> Number of pits-----�----------------Lining material-_ _� Sie: Diameter--. --/-..---Deptn--.-.-------________----rf" L <br /> Cesspool: Distance from nearest well----------------- from foundation................... Lining maferial------------------------------------- <br /> ElSize: Diameter---- ----------------------Depth-.--------------------------'---- ---------------.Liquid Capacity---------------------- ----gals. 'C <br /> Privy: Mstrance:.;from nearest well------____________________-_.--.__.____-----.--Distance from nearest building------------------------------------------ <br /> ❑ Distance,to"nearest lot line_------------------------------- -------------------------------------------------------------------------­--•--------- -------- <br /> Remodeling <br /> - ----Remodeling and/or repairing (describe):--------------- "-------- ------ -------------------------------------------------------- <br /> ------------------- ---------------------------------------------•------------------------------------------------------------------------------------------------ ---------•------•--------------- <br /> -------------- <br /> ----------- <br /> ---------------------------------------------------------------------------------•-------------------------------------.-----•---.---- ------------------ ------------------------------------ . ..... <br /> h I hereby certify that I have pre ared this application and that the work will be done in accordance with San Joaquin Count <br /> ordinances, State I w , rid rules n re ula#ions of the San Joaquin Local Health District. <br /> t <br /> (Signed)-, ------- ------------------- --------------------------- - (Owner and/or Contractor) <br /> By: � rttle <br /> [ )-- <br /> B <br /> (Plot plan, showing size of to , I cation of system in relation to wells, buildings, etc.,.can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> Y APPLICATION ACCEPTED BY_ __________ DATE----------------- ' <br /> REVIEWEDBY--------------------------------------------- --------------------------------------------- ------------------------- DATE---•----------- ------------------------------------------- <br /> BUILDINGPERMIT ISSUED-------------------------------------- ----•------------ ---------- DATE------------------------------------------ ----------------- <br /> Alterationsand/or ecommendations----------------------- -_------------ '-----•---------------------------------------- --- ---------------------•------------------------------- <br /> /J <br /> FINAL INSPECTION BY:---------- 'rj-'� 6 ----------------- <br /> Date ---------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1801 E.Ha:eltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca, California Tracy,California <br /> F.P.EO. t <br /> G <br />