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FOR OFFICE USE. <br /> -1A <br /> ----- ------- -------------------------------------- <br /> -------- -------- ----------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> -------------- ------------------- (Complete in Duplicate) <br /> ------------------------------------- ---------------- This Perimit' Exefres 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 heiein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> 40T_ 15-2- 720 <br /> JOB ADDRESS AND LOCATION_,----------------------- B <br /> -------------------------------------------------- -------------- <br /> Owner's Name--------- <br /> ------------ 11 <br /> ------------------------------------------ Phone----••---------------------- <br /> ,, Address <br /> hone----------------------------Address----------------P_,Q........ -------------3 <br /> R 8.O.'F>------------------------------------------------------------------------------------------ <br /> Contractor's Name-------------FQ"E F!, <br /> ------------------------------------------- --------------------------------------------- ----------------- Phone----------------------------------- <br /> Installation will serve: Residence a Apartment House E] Commercial ❑ Trailer Court E] Motel 0 Other E] <br /> Number of living units: ---I---- Number of bedrooms 3... Number of baths ---(__ Lot size -----Z�_(22q0-----q__--------------------------- <br /> Water"Supply: Public system R--c-ommunity sysfemE] Private F-1 Depth to Water Table --------\ft. <br /> Character of soil to a depth of 3 feet: Sand LTJ Gravel [] Sandy Loam E]. Clay LoamE] . ClayE] Adobe E] Hardpan F <br /> Previous Application Made: ',(If yes,date____________________) No New Construction: Yes Rr'N. ❑ FHA/VA: Yes 0---No D <br />�-ST-Y-PE-OF.;INSTALLATION4A-ND-.SPECIF-ICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic T nk: Distance ;from nearest well__-C-!_VJ___D1stanvc from foundat�on___Jja---------Material C-Pf)ics_g�_T---T- <br /> ------------------ <br /> No. of compartments_._____ X— ----X1 Q_X-Li -Liquid depth__.- ----Capacity— -------- <br /> Disposal Field: Distance,from nearest 11 Distance from-fouoo .71------------- <br /> T e ------ tion____________________Distance_ ------------------ Distance to nearest lot line <br /> _T,___._________ <br /> of lines______ --------------------------Length of each ---Width of trench___.__..__ ��._________- V ' <br /> Type <br /> rench------ <br /> Type of-filter material__AO!;cK-----Depth of filter material____._i17----------Total length----------- --------------- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line------- --------- <br /> El Number of pits----------------------Lining material-----------------------Size: Diameter------------- _------Depth---------_------------_---------- <br /> Cesspool: <br /> epth--------------------------------- <br /> Cesspool: Distance::from nearest well-----------------Distance from foundafi'n-------------------Lining material---- --------------------------------- <br /> I <br /> Size: Diameter------------------------------------------- -----------Depth--------------------Depth------------------------1—-----------------Z-------Liqu;d Capacity...------------------- ----gals. <br /> Privy: Distance from nearest well------ -------- --------------------------------Distance from nearest building___._...______.._______________._______.__ <br /> ❑ Distance.to <br /> uilding------------------------------------------ <br /> Distance.to nearest lot line------------------------------- ----------------------------------------------------------------------------------------- -------------------- <br /> Remodeling and/or repairing (describe):----------------------------------------------------------------------------------------------------------------- ------------------------------- <br /> -----­---------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---- ---- ---- ----- <br /> ---------------------------------------------------------- --------I----------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -------------- -------------------------------------------------- <br /> ------------------------------------ W� -------4 ----------------------------------- ----------------------------------------------------------- <br /> I hereby cert*f that' " e preppred this application and that the work will be done in accordance with San Joaquin County <br /> y q+ <br /> ordinanc6s, t tolarrs, rules ules and' regulations of the San Joaquin Local Health District. <br /> ---- ----------- <br /> (Signd)-------i---- --- - ---------------- ----------------------------- ---------------------------- ---------(Owner and/or Contractor) <br /> —(Title)----—------ <br /> ----------------------------------------------------------------------- - -- - ------------- ------ - ------- --- ----------------- <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------- ---------------------------------------------------------------- DATE------- -------------------- <br /> REVIEWED BY------------------------- <br /> --- ----------- ----- --------- --- ------- ----------- ------ -------------------------------------- DATE----------------------- ---------------------------- <br /> BUILDING PERMIT ISSUED—'--------------------------------- ------------------ ----------------------------------------------- DATE----------------- ---------- -------------------------------- <br /> Alterafi6ns'and/or recommendations:--.---`-----------I-------I ------------------ ----------------------------------------------------------------------------------------- ---------------------- <br /> --------------------- ------------------- --------------- -------------- ---------------------------------- ---------------------------------------------------------------------------------- <br /> ------------------- <br /> ----------------------- -------- ------------------­------------------ ------------------------------------------------------------------7------------------------------------------------ ----------------------------- <br /> ---------------------------- <br /> ----------------------- ---- -- - --------------- ------ ------ -------------------------------------------- ------------------------------------------------------------------- - <br /> ----- ------------- <br /> FINAL INSPECTI Y_ ------ Date----------------- <br /> SAN <br /> ate-----------------SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F..PICO. <br />