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FOR OFFICE USE, I <br /> --------------=----- -- ----------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------------------------- ------ ------------------------ <br /> (Complete in Duplicate) <br /> This Permit Expires 1 Year From Date issued <br /> Date Issued ___� <br /> _ . <br /> ----------------- ._.._ _-------__.___._--_.______.._._ <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 <br /> is made in com ia <br /> F County Ordinance No. 549. <br /> 7 <br /> t <br /> JOB ADDRESS AND LOCATION n7 ce with <br /> 7Y �/f A X _1/(/ LL------------ _4M-RO-I--------------- <br /> Owner's Name------------D_4j_..1,.-I-P-5-------(fQN-r` ------t <br /> ----- ---------------------------------- -- Phone------------------------------------ <br /> BOX.------- 3 a-� -----/RTH OP------------------------------------------- <br /> Address-------------------- --=-�-'----- -------------------------------------------- <br /> � <br /> Contractor's Name------F__t.?_"_E_K------------------------------------------- --------------- -------------------------------- Phone. ... <br /> Installation will serve: Residence �Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 3 <br /> Number of living units: -1----- Number of bedrooms 3-.. Number of baths __/__ Lot size _1047....K-Jap------------------------ <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to as depth of 3 feet: Sand�[ Gravel�iv ❑, Sandy Loam E]_ Clay Loam ❑ Clay ❑, Adobe[-] Hardpan C]Previous Application,Made:.,(If.yes,date_=--TM---,-------:) -No �'New Construction:-Yes EA­1�o ❑ FFiA/VA: Yes ©�No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> �(No'septic tank�or ce'sspool permitted if public sewer is available within 200'feet:)'— <br /> 1 i s <br /> Septicank: Distance from nearest well_._ -__r�Distarice from foundatioq---_ ______p'._ _ Materi I-_CQ/.�-r� 7�--------�I + No. of camp _________ <br /> artments______ _ __ <br /> --- --Size X � X`� Liquid de th-----J� Capacity---f 2QC <br /> Disposal Field: Distance from nearest well._�C.r_V�-Dii n;c from foundation___- --------Distance to nearest lot line___ <br /> Number of lines___.�J`_ i ------ ---Lengfh 7of.each.line- of..trench___.__ .._l______ <br /> (Type of filter material-_ p. -----.Depth of filterlmaterial'"�kI.'l--.'-------Total-length------ <br /> _- <br /> Seepage Pit: Distance to nearest well-------------------- Distance from foundation--------------------Distance to nearest lot line----------------- <br /> ❑ 1:Number of pits----------------------Lining matelot--.-------.-----------.Size: Diameter-----------------_---Depth--------------------------------- <br /> 1 * I <br /> Cesspool: Distance from nearest well-.._____.-___ IF. <br /> Distance from foundation------------------_Lining material-------- ---_._____-______._____.___. <br /> ❑ Size: Diameter---- -•- -------------------- Depth-------- --------------- --- ------------------..Liquid Capacity------------------------- •gals. <br /> Privy: Distance from nearest well-------------------_-----------------------------Distance from nearest building-------_______._________________-..------ <br /> Distanceto nearest lot line------------------------ - - --------- --------------------------------------------- ---------------- ------------------------------ <br /> Remodeling <br /> - ------------------------Remodeling and/or repairing (describe)-. ----------------- --------------------------------------------------------------------------- -------------------------------------- ----------------- <br /> _ r <br /> -------------------------- -----------------•-------;---•-•-----------------------------------------------=-`-- -I------ A l-- --------------------------- - - <br /> -------- - ---•°------------------------------------`------------------------------------------------------------------------------------------------------------------------•------•-----•--------------------------------- <br /> I hereby c ify that I hav repared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, S e laws, and and ulations of the San Joaquin Local Health District. t <br /> (Signed) --------------.:- - --------------------------- - --------------- (Owner and/or Contractor) <br /> = ----------_-----..- :-. ------ --_--`---_ -- - `p " :(T' e) <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------77--4.R__V-'.....-- ---------------------------------------------------------- DATE---------` ------------- <br /> 4 REVIEWED BY----=----- -------------------------------- -------------------------------------------------- ----------------------------- DATE-------- -------------------------------------------------- <br /> BUILDINGPERMIT ISSUED-------------- ------------------- --------------- -- ----------------------------------------------- DATE__------------------------------------------------------------ <br /> i _ .__. ,. �..... .-� _ <br /> � Alteration s end/or recommendations:-.------------- -- - ----------------------------------------------------------------------------------- ------ -- -• ---------------------------- <br /> ---------------------------------- ----------------..-------------------------------------------- - ----- -----------------------------------------------•--------------------------------------------------•- <br /> f -------------•---- --------...... ---- y <br /> FINAL INSPECTII ------Z - <br /> ----- ----- ------ ------- - Date........ �� -� ---------------- - - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> k1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracyr California <br /> F.P.Cfl. <br />