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FOR OFFICE USE. <br /> ----------------__-- _ APPLICATION FOR SANITATION PERMIT Permit No. <br /> ----------------- --------------------- ------ (Complete-in Duplicate) <br /> This Permit Expiri s"I'Yea -From Date Issuea - `trate Issued .. <br /> - - a <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 ADDRESS ANQOCATION------- ------ T y r ------------------------ <br /> / -- - --- ---------------------- <br /> Owner's Name---------- -`--------------- -- Phone ' <br /> Address-------------------------------------------- .�- <br /> Contractor's Name---- ----- Phone <br /> r�aG� --- -- --------------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court [❑ Motel ❑ Other ❑ <br /> umber of bedrooms -_ .-_ Number of baths J.. Lot size --_ -1f1 / <br /> Number of living units: __ <br /> Water`-Supply: Public system 'Community system ❑ Private ❑ Depth to Water Table ------ _ ft <br /> Character of soil to a depth of 3 feet• Sand E] .,Gravel E] ',Sandy Loam ❑ Clay Loa;'[:] Clay ❑ Adobe ardpan ❑ `! <br /> Previous Application Made: (If yes,date................... ] No [/New Construction: Yes 5;<0 ❑ FHA/VA: Yes E] No' <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 /> .. <br /> J _ . No. of compartments--------------------------/ Size------- - -----------Liquid depth--------- - --- .------ Capacity------ ----- <br /> Disposal eld: , Distance from nearest well-...Ilf Distance from foundation_._./_Q./._.._.Qisfiante to nearest lot lin -_- ---.-- <br /> Number of lines_____-- I -._-_ _______Length of each line.____._-_ --------- <br /> - <br /> 4 Width of trench----------�.�_________________ <br /> J �i ; <br /> Type of filter material_-._. - 0 - -----Depth of filter material..- .1-( ..._...._._Total length_- - -- --------_---___-._ <br /> �,/ G E <br /> Seepage Distance to nearest well_.__..�A71.�.._-p;stance f om foundation------`._.__.....Distance � nearest lot lin <br /> �___�.__.._ <br /> Number of pits... ._.__ ------_.--Lining material--- k� Size: r---*X-__f-----.Dept h....../Q-------------------- � <br /> Cesspool: Distance from near st well --_-----------.Distance from foundation... .......... ..Lining material......... -------------_----.--.._-. ' <br /> E❑ 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)------- ------------ ---- -- ---------- --- t-- ------------------ -•------------------ <br /> ---•-------•-•--•------------------------ -------------------------•---•------------------------------------------------- ------------------------------------------------------­ <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 (a s, and rules and re ulations of the San Joaquin Local Health District.l <br /> (Si ned <br /> g ------------------ ----------------------- ------ --------.-------------------- (Owner and/or Contractor] <br /> By--------------------------------- ---------------------------------------------------- ------------•--------------=---------------(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-- ------ =- '---------------------- --------------------------- --------- DATE------ <br /> REVIEWEDBY---------------------------------- ------ - --- --------------------------- ----•--•------------ -------- ------ -- ------ DATE <br /> BUILDINGPERMIT ISSUED-------- -------------------------------------- --------------—--- ---- ---------------------- DATE--------------------------- <br /> Alterations and/or recommendations:.....---------------- --- -- ------ ------ - ---- ---------------- ----------•---•------------- ------------------- --------------------•-------------------- <br /> ---------------- ----------------- ------- ----------- ............ ---------- .------------------------------------------------------------ <br /> ------------- ------- ------------------------ ---- -------------------- <br /> ----- -------- -- --------- --------------------- <br /> F1NAL INSPECTION BY:.- -------------- ----- - ------- Date........ ------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton California Lodi, California Manteca California <br /> + + Tracy,California <br /> F.H.9 2M 1-67 Vanguard Press v. Via- 4 6 <br />