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FOR OFFICE USE,. 4 <br /> ------------------------------- ----------..- <br /> APPLICATION FOR SANITATION PERMIT Permit No. ___C2_- <br /> - --- -- ---------------------------------- ---- (Complete-in Duplicate) <br /> This Permit Expires 1 Year From Date Issued Date Issued <br /> �{E Ssf a n 7 <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and m all thee work herein described. <br /> This application is made in compliance with County Ordinance No. 549. y ( ��_p l <br /> `f f� L <br /> JOB ADDRESS ANDJCATIO �----i'_pI�I_#�.AIURRH- 1 v`'`'� f l7-Q <br /> Owner's Name yu `= r7- 1- [ -r------------- -- Phone5-71_ :--------------- <br /> Address <br /> -�t'�- <br /> Addressr ® �i--1--- - ftj- �------------------------------------------•-- ----•--•----------•----- <br /> r Contractor's Name-----l0_WY 1,-�Y------------------ --------------------------- ------- ------- -- -------------------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court [] Motel ❑ Other ❑ <br /> Number of livingunits: __F.___ Number of bedrooms __.rr1 <br /> Number of baths _�_____ Lot size __/�R1=��Z�___.._______________________ <br /> Water Supply: Public system ❑ Community system ❑ Private n/Uepth to Water Table fQ_ ft <br /> t/Ek�y <br /> Character of soil to a depth of 3 feet- Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ ` <br /> Previous Application Made: (If yes,date_................. I No�ew Construction: Yes ❑ No Er_'FHA/VA: Yes ❑ No Es] - <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 _.___-- ---------------------------------------- <br /> E_ ®' /445-- No. of compartments______________-. <br />' ----------Size-----•-- --=------ -----------Liquid depth--------- ------- --- CapacitY-------------------- --- <br /> Disposa# Field: Distance from nearest well.-_ .�__Distance from foundation..--- .........Distance to nearest lot <br /> F3iff,7 ff6r- Number of lines._-_______./.._-------------------Length of each line_: .__ _�_.rr___._--Width of french---_---;;� fir________________ <br /> Type of filter material. Depth of filter material---- �_ -----------Total length---------,SO_ <br /> Seepage Pit: Distance to nearest well..__________________Distance from foundation--------------------Distance to nearest lot line-------------- <br /> Number <br /> ____..._____.Hum er of pits--- ------------------Lining material----------------- Size: Diameter----------------- - ---Depth----------------- ------ ` w <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 - ------------------- --------- <br /> Remodeling <br /> -------Remodeling and/or repairing (describe):._.-_.-_ LTJ}CJ-1-----L-LN-�------r ....... ----�����✓I <br /> ------------------ -----------------­ ---- -------- ----------------------------------•------------------------------------------------------------------------------- ---------------------------------------------- <br /> I hereby certify that I leve prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, an d ru es and regulations of the San Joaquin Local Health District. <br /> tt- f ; <br /> T(Signed) .. = _ - —: _ ..w............ . ------- -.(Owner and/or Contractor). <br /> �. - -,r-By:--------------------------------------------- --- ---- ------------------------------ ---- --------------------------------- -----(Title)--------- ------ --------------------------- ------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------ --r, Q' - DATE__ <br /> --------.... �7- � - ----------------- <br /> REVIEWEDBY - - --- -------------------------------- -------- ---------------------------•-------- DATE_- ------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED-------- ------------------------------------------------------------------------­ -- ------------ DATE----- -- ----------------------- <br /> Alterations and/or recommendations:--------------- - - ----------- --------- ---- ------------ -------------------------------- ----------------------------•-------------------•- <br /> FINAL INSPECTIO /•� ------ --- Date---------- d1Z' �. - V <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT ; <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi. California Manteca,California Tracy,California <br /> E.H.92M 1-67 Vanguard Press <br />