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FOR OFFICE USE: <br /> -------------- <br /> ------ ---------- <br /> V - ------- --- <br /> APPLICATION FOR SANITATION PERMIT Permit No. . ........... <br /> --------------- ------------------ ---------------- (Complete in Duplicate) <br /> -9- <br /> Date Issued -4------- <br /> --- ------ ------------------------------------------ This Permit Expires I Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work hgein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOS ADDRESS AND LOCATION---------e7 -------- ------------------------- <br /> 6"11A"�_ ------- rp� <br /> Owner's Name-----------------kay........ ------------- ----------------------------- ---------------- Phone---9-falt-1- <br /> Address------------ --------- -- - -------------------------------------------------------- ------------- <br /> ----- -------- - <br /> Contractor's Name----------------- -------------------------------- ------- ------------------------------------------------------- Phone-----------..---------------------- ti� <br /> Installation <br /> hone----------------------------------- <br /> Installation will serve: Residence [partr'nent House E] Commercial 0 Trailer Court I E]- Motel E] Other ❑ <br /> Number of living units: __4--- Number of bedrooms _*--- Number of baths __y Lot size ------ <br /> ------- ---- -------------------------- <br /> Water Supply: Public system E] Community system E] Private XDepth to Water Table _VA_ ft. <br /> Character of soil to a depth of 3 fee+: Sand [] Gravel E] Sandy Loam [] Clay Loam Ej Clay ❑ Adobe M �Harclpan 11 <br /> Previous Application Made:5 (If yes,date.-r---------:--------) No �NeConstruction: Yes �No [I PHA/VA: Yes E-] No Ems" <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if PU61i ewer is available within 200 feet.) <br /> Oil <br /> Se Tank: Distance from nearest N-Y-Disfance from founclation_1---r M f <br /> ------- virial-T <br /> No. of compartments----____-->-----------Size-- -_ Liquid clepth--------- ---I? <br /> Dis Field: Distance from nearest well J-0------Distance from founclaft----ji---------Distance to nearest lot line- <br /> N r,.of lines----__4------- ------- ---- ---- / <br /> pe Number, Length of each line------------/J---------------Width of trench-------x------- -------------- <br /> epfh L / <br /> Type of'filter�maferial_4 ..--D of filter material-.-"-"_ -----Total length--_-_-----;t ------------ <br /> Seepage Pit; Distance to nearest well-- - 1-----------Distance from foundation....................Distance to nearest lot line__..--------_---_ <br /> ❑ Number <br /> ine----------------- <br /> Number of pits----------------- ----Lining material-------- n.... Size: Diameter-----------------------Depth--------------------------------- �ny�f <br /> Cesspool: <br /> epth--------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance.from,foundation.-------------------Lining material-_.-_..-------.----.------"---------. <br /> Size. Diameter----------------- ------------------Depth-----------I-------------------- <br /> --.-_____--._Liquid Capacity----------------------------gaA.---. <br /> Privy: Distance from nearest well----------------------------------------I---------Dstance from nearest building-...------------------------------- ---- <br /> F1Distance to nearest lot line----------------------------------_------------------------------------------------------------------------I----------------- ----- <br /> Remodeling and/or repairing (describe)*--------- ---------------------------- ------------------------------I----------------------------I-------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -----------------------------------------------------------------w--------------------------------------------------------­----------------------------------------------------------------------------------------- <br /> --------------------------I-----------------------------------------------------------------------I--------------------------------------------:------------------------------------------------------------------- <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 /> (Signed)-------------- - ------- <br /> --------------- 7----- ------------------ -----------------------------------------------------------------------(Owner and/or Contractor) <br /> By:----------------------------------------------------------------------------- -------- --------------------------------------------- ------------- <br /> (Plot plan, showing size of lot, location of systein in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- -------- --------------------------------------- DATE-------- <br /> ------- --------------------------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED--------------------------------------------------------------------11--------------------------------.- DATE---------------------------------------------- ---------- <br /> Alterationsand/or recommendations:------------------- ------------------- --------------------------------------------------------- ------------------------------- ----------------------------- <br /> ---------------------------------------------------------------------------------------- ---------- --------------------------- --------------------------------------------------------------------------------------- <br /> ------------------------- ------ -------------------------------------- ----------------------------- ------------ -----------------------•- ---------------------------------------------------------------- <br /> --------------------------------------------------------------- -------- ------------ ---------------- --------- ------- --------------------------------- ------------------------------ - Y <br /> -------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------- --------- --------------------- <br /> -------C26/,�L-------------- te A ...... <br /> FINAL INSPECTION BY.-'-,--.... ...... <br /> SAN JO UIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hosellon Ave. 300 West Oak,S eel 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,Coliforni Manteca,California <br /> Tracy,California <br />