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FOR OFFICE USE: ; '`1 <br /> _ ____ _ <br /> APPLICATION FOR SANITATION PERMIT Permit No. 4.G_.:._ � <br /> .......... ---- ------­-------------- (Complete-in Duplicate) <br /> _____________ This Permit Expires 1 Year From Date Issued 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 /> JOB ADDRES D LOCATION <br /> - <br /> Owner's Nama�L.•m ® o Phon ^t--�`�--- <br /> �- " <br /> Address - ••............. - - -------- ----•--- - <br /> � ��� ` [� <br /> -------- <br /> p <br /> Contractor's Nair 77�e ____�41. ------ .0 -- - - -- ----- -- ----y-- ------ Phone*" 1-- <br /> ' Installation will serve: Residence;K Apartment House Commercial Trailer-Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _1-.___ Number of bedroom_ Number of baths__j.._ Lot size ____0- ft- <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 E] Clay ❑ Adobe, , Hardpan ❑ <br /> Previous Application Made: (If yes,date__--- _------ ._. ) 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.) <br /> tic Ta�k Distance from nearest well------_----------Distance from foundation--------------------Material -------_........._--------V_'-_"' <br /> No. of compartments-------------------------Size-------------------- -----------Liquid depth--------- - - - --------Capacity----- ----------------- ` <br /> 11 <br /> Disposal Field: Distance from nearest well__'..............Distance from foundation__�_0_�__.._.Distance to nearest lot line-- _. \ <br /> Number.of lines--�- Length of each line-_`7• ��______________Width of trench. .. !!._...._____.____. (�3 <br /> - <br /> Q!i Total len <br /> Type of filter materia _Depth of filter matenal._l_77 f gth___..__...�> V <br /> Seepage Pit: Distance to nearest well_.*- Distance from foundation---LO---------Distance to nearest lot line__.______- ' <br /> Number of its___ ------Lining material__ka.d, ____.. Size: Diameter__ _ Depth____ <br /> p `r�s .----------- <br /> Cesspool: Distance from nearest well -------__._Distance fror foundafiion...._______.___- ..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------ ----------------------------- ------------------------------ ------------------ ------------ ------ - ------------ ------ --- <br /> Remodeling and/or repairing (describe): Q- o A---- --- <br /> ----- -------- <br /> I - -- <br /> ---------- ---------------------------------- ---------------------------------------------------------- ---------------------------------------------------------------------------------------ti <br /> --- r <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, St aws and rules and regulations of,0e San <br /> � Joaquin Local <br /> (Sign <br /> ---- r Contractor) <br /> By---------------------------------r------ •------------------------- ----------------- ---------------------------------- ---(Title)---------- --------------..-------------------..--------------- <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--- -----. if ------------ ------ --- ---------- DATE----- � �_ _�.---------------------------- <br /> REVIEWEDBY--------------------------------------------------- - - DATE------- ------------•-•------ ------------------------------ <br /> BUILDINGPERMIT ISSUED-------- -- -------------------------------------------- -------------------------- --------- DATE-- ------ - ------ --------- <br /> Alterations and/or recommendations------- --- ---- - ---- -- - ---- - -- -- ----- --- ----------- -------•-----------•-------------------------------- ------------------------ --------•------- �. <br /> ---------- -----•--- <br /> ----------------------------------- --- - ----- ---- --- =------ ----- .................................... •---------------------------------------------------------------- ------------ -------------------------- <br /> FINAL INSPECTION BY: �• 1��� �� '� Date ....... ---------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> i <br /> 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi, California Manteca,California Tracyr California <br /> E.H.9 2M 1.67 Vanguard Press e/ <br />