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FOR OFFICE USE: <br /> /.. __-.-. APPLICATION FOR SANITATION PERMIT Permit No. _ ... ..___ <br /> ------------- -------- --------------- - ��----- (Complete-in Duplicate)licate) Date Issued <br /> ............... ----------------------------.--- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and insta4l the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> ---------CAA.,-t+ -, _ °° ° a_--------- O- ------------------------ <br /> JOB ADDRESS AND L CATION____ _______ ______ ___ __ --- <br /> Owner's Name------------Y..,E_4577 .......... ------------------ -------- --------------- ------------ Phone.7-7Z44_ <br /> Address-------------------- ----- `-- - ----------------._. ------------------ ---------------------- <br /> Contractor's Name----F A- -1 ------ „--- ------- --- -------------- Phone_ - - <br /> Installation will serve: Residence * Apartment House .❑ Commercial ❑ Trailer Court ❑ Motel E] Other E]Number of living units: A---- Number of bedrooms _ ._ Number of baths___.._µLot size ..../--. A.Cl_�____ ----____________________ <br /> Water Supply: Public system ❑ Community system❑ Private Depth to Water Table0 ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe X Hardpan ❑ <br /> Previous Application Made: {If yes,date---------- ------ ] No`t New CConstruction:iYes ❑ No Dd. FHA/VA: Yes ❑ No <br /> TYPE"OF INSTALLATION AND SPECIFICATIONS: 4 r CJ <br /> (No septic tank or cesspool permitted if public sewer,isavailable within 200 feet.) <br /> Septic Tank: Distance from nearest well________________Distance from foundation-------------------- Material ------------------------------------------------ -- <br /> ❑F1 <br /> 1 ST No.-of com artments------- --- --- ----_a...Size------------------ - -- _---Liquidui_d depth--------- ------- --------Capacity. --- --- ---- ------- <br /> t <br /> t I .4 <br /> Disposal Field: Distance from nearest well---&. _.._Distance from foundation___ ---------Distance to nearest Iodine-_- __..-.. <br /> Number of lines . _ ��._.______._Length of each line_. _ ...__ _ Width of trench__ ___________________ <br /> - �y t ® ; <br /> Type of filter material__ ____-.Depth of filter material----------- __t------Total length_...___._-_______Z--_____________ <br /> Seepage Pit: Distance to nearest well._.__._______________Distance from foundation--------------------.Distance to nearest lot line__.__._._____ _ <br /> ❑ Number of pits--- ----------------..Lining material-----.----_ Size:.Diameter---------------------.Depth_..------------------------------ <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--------------------.__-______-._._..__--- 1 <br /> Distanceto nearest lot line --- ---------------------------------------- ---- --------------------------------------------------------------------------------- <br /> Remodeling and/or repairing {describe):__:- ..-.-._- ._I-_--�- 4_ ___________ ___ __ <br /> . -- ------- ------- ---------------------------------- <br /> ._ --= —' - ---------- - <br /> ---------------------- <br /> ---------- ----------- -.-:-------------------------------------------------------------•---------------•-------------------------------------------------------------------------------------------------------- - - <br /> I hereby certify that I have preps d this applicat'an and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules end gulations of t e San Joa uin Local Health District. <br /> (Signed) - ----------- ' - ----------- f (Owner and/or Contractor) <br /> r , <br /> By•----- f i _'''� �Title� : <br /> Plot Ian, showing size of lot, ocation of system in relation to weir, buildings, etc., can be placdl on reverse side). <br /> � P <br /> O DEPARTMENT USE ONLY ` <br /> APPLICATION ACCEPTED BY - -- ----------- ----------- ------------------------- --- ---------- DATE -_� -U <br /> REVIEWEDBY------------------------------------- ------------------------------------------------------- DATE-------- • -------------------------- <br /> BUILDING PERMIT ISSUED---------- - -- ------ ------- ------------------------ - DATE <br /> Alterations and/or recommendations--------- - --- ---------------------------------------------- ---------------- --- ------------ ------- ---------------------•--- <br /> ------------------------------------- <br /> --------------------­­------ ------ -------- -•- --------- -------------- ---------------- -----------------------------------------------------------------------•-----------------•----•--•----------- <br /> ---------------- <br /> -- ------------------- ----------- ----------------- ...................... -------------------------•----------------------------- -------------- - - ---._....------------------------------ <br /> ------------------------------------------ - ----- ----- .......... ------------------ --------------- . .--------------------------------- ---------- -------- ----- <br /> FINAL INSPECTION BY:_.... -c -----__ Date------------------- � .C � <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street <br /> Stockton,California Lodi. California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />