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FOR OFFICE USE: <br /> APPLICATION FOR-�-- - -.--�_-_ --�� --�-------�--_�---�------ _�- -_..- R=SANITATION PERMIT Permit No. . _�_�� • <br /> (Complete-in Duplicate) <br /> ------------.--- This Permit Expires ] Year From Date Issued Date Issued <br /> I Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. <br /> This aplication is made in compliance with County Ordinance o. 549. ., poS— r3or z�J <br /> JOB ADDRESS AND LOCATION._C��v�sp - - --- - - ---- _�'.` -- --- -----........... <br /> --- -�._. - - -----------•--------------------------- <br /> Owner's Name y .el�!..-----""- ----------•--------------- ---------- --------.....-..----------------------------------... Phone <br /> Address ------- P-9--- <br /> Contractor's Name---------- -- - -------- ------- ----------------------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: j_--- Number of bedrooms . Number of bafhs ---.I--- Lot size ----- --- ----------------- -------__________---_-_--...... <br /> l Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table V _ ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam P 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: G7 <br /> No-se'tic tank_or cess ool errniffed if, ublic sews-?_is available wifhin_200:feef. <br /> Septic Tank: Distance from nearest well---------------.Distance from foundafion--------------------Material -----------------"_"------------------- <br /> ❑ No. of compartments--------------------------Size------------------- - -----------Liquid depth--------- _ ---- --------Capacity.............. -------- <br /> Disposal <br /> Field: Distance from nearest well----.-.____-.--Distance from foundation....................Distance to nearest lot line______....-.----- � <br /> ❑ Number of lines----------------------------------Length of each line--------------------------------Width of trench----------------•------------------ <br /> t„ Type of filter material--.__----.-_--___.----Depth of filter material______________________Total length------_..._.--------__.__.___--_---._...._ <br /> Seepage Pit: Distance to nearest well---f_F'4_-.-_...._Distance from "foundations5�---._----- Distance to nearest lot line._1_ -------._ <br /> _._..-Linin material----- t1 -- Size: Diameter..... .. ..............De tn_1...C.___._.._-_ <br /> Number of pits-- A------- g �� p � � -- ------- <br /> Cesspool: Distance from nearest well ................Distance from foundation................. ..Lining material-_--__.-._-_-----_.--__._.__----._. <br /> ❑ Size: Diameter- -- --------- ----- -------_-----Depth------------ - -------------- ----------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest weft....-----------------------..__...._-..---------Distance from nearest building--__-_--.._-_-____-.__.-.---------------- <br /> ❑ Distance to nearest lot line-------- ---------------- -------------------------------------------- ---------------------------------------------------------------------- <br /> iRemodeling and/or repairing (describel:---------------------------------------------------------------------------------------------- -------- -------------------------- <br /> -------------------- <br /> r. <br /> y __________ ---------------------------------------------------------------— <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 /> (Si ned)- - --" -------------- (Owner and/or Contractor) <br /> ------ <br /> y: _:,,_ — — --------- -:-....(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--- - �� '�. ,Z�--- ------ --------------------- -------------- DATE.60--3r-- -6.7-------------- ----------------- <br /> tREVIEWED BY--------------------------------------------- ------ DATE----- ------------------------------------------------------ <br /> BUILDING PERMIT ISSUED-------- -- ----- - ----- ------------------------------------------------------------ ------------- DAZE--- -------------------------------- ------------------------ <br /> Alterations and/or recommendations:------------------ ------------------- -- ----------- --------- ------------------------------------------------------ --------------... <br /> --------------------------------=----- - ------- ------------------------- ------------------------------------------"--• ---------------------------•------------------------------ <br /> i ------------ ------- --------- --------------- - --------------------- -m---------- -------------•-------------------- -------------- ----_------------- ------------------------------------- <br /> ------------- ------------------_--I------------------ - - -- - ---- - ------------------------------------------------------------------ ------------- -------------- ----------- - -- -- ------------------------ <br /> € <br /> FINAL INSPECTION B -- - -- - ---=----------------- Date_ <br /> h -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ma:eiton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi. California -w x Manteca,California Tracy,California <br /> y, <br /> E.H.9 2M 1-67 Vanguard Press - <br />