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FOR OFFICE USE: <br /> ----------------- <br /> I / <br /> f! ---- <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> --------- ------------ -------------------------------- (Complete in Duplicate) Date Issued <br /> ---------------------------------- --- --I------ 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 -install the work herein described. <br /> This application is made in compliance with County Ordi ante NO. 549. <br /> *2 e ---------------------------------------___--_------------------------- --------- <br /> JOB ADDRESS AND LOCATION-J-3/ /Z - <br /> Owner's Name------- -----------------------------------------------­--------------------------­---------------- Phone-------------------------- <br /> Address-------'S�'-we-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> Contractor's Name--------_-- ----------------------------------------------------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence 91_ Apartment House E] Commercial E] Trailer Court [3 Motel E] Other El <br /> Number of living units: __/__ Number of bedrooms o2.- Number of baths _Z___ Lot size - --------------------------------- <br /> Water Supply: Public system W11-Community system [-] Private F Depth to Water Table ft. <br /> Character of soil to a depth of 3 feet: Sand E], Gravel E] Sandy Loam E] Clay Loam [] Clay E] Adobe [41-'T�Iardpan C3 <br /> Previous Application Made: (if yes',date--------------------) No ��New Construction: Yes [] No © FHA/VA: Yes [j No gg­ <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 /> �IJ&_I-f Ir4f No. of compartments---------------------------Size__-------..---------- -- Liquid depth--------- ----- -------Ca acit Disposal ;-ield.; Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line----------------- <br /> �,(eV Number of lines-----------------------------------Length-of each line------------------------------Width of trench------------- ------ <br /> Type <br /> rench----------------------------------- <br /> Type of filter material-------------------------Depth of filter material----------._----f.---Total length--------..---_---_----.--_------ ----_ I <br /> Seepage <br /> ength-------------------------------- ----- <br /> Seepage Pit: Distance to nearest -----Distance from fou ridation-13,9--------rDistance to nearest lot lin <br /> Number of pits------�---------- Lining material--- Diameter--_73r,--- Depth- ----------- ...... <br /> Cesspool: Distance from nearest well-----------------Distance from foundafion_-------------- - Lining material---.------..--..---..-.----------.---. <br /> ❑ <br /> aterial-------------------------------------- <br /> ElSize: Diameter--------------------------------------Depth----------------------------- ----------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------- ---------Distance from nearest building-____--_-_-______________-_____-__. <br /> ❑ <br /> uilding------------------------------------------ <br /> El Distance to nearest lot line------------------------------ <br /> ----------------------------------• <br /> ----------------------------------I--------------------------I-------- <br /> Remodeling and/or repairing (describe)---------- ------------ la-------� ,0616 ----------------------------------------------------------- <br /> --------------•----------• -I------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------I------------- -------- <br /> -------- ------------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)------------------ -------- ------ ----- ----- -(fid/or--C---o--n--t-r--a--c-t--o--r-) <br /> By:- -------- - (Title)_ <br /> (Plot - <br /> plan, showing size of lot, location of sy in relation I to wells, buildings, etc., can be placed on reverse side). <br /> 17' FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------------- ------------------- ---------------------------------------------------------- DATE----------1---------------6 ----------------------- --- <br /> REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE--------------------------------------------------------_ i <br /> BUILDING PERMIT ISSUED--------------------------------------------------------------—---------------------------- --------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations---------------------------------------------------------------------------------------------------------------------------------------------------------------_ <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> --------------------------------------------------­---------------------- ------- --- ---------------------------------------------------------------------- --------------------------- --------I-------------- <br /> ­_­­-------------­--------------------- ------------------- ------------------------------------------------ ---------------- ---------------------------- -------------------------- ----------- <br /> -------------------------------------- ------------------------------ ---------------------------------------- -------:---------------------------- -------------------------------------------------------------- <br /> .Cp Date............ �­7 1,4' '�' <br /> FINAL INSPECTION BY:..... ..e---n..... --------- _V. ----------/-------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />