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FOR OFFICE USE: <br /> ----------------------------------- - ------------ ----- <br /> 7 <br /> --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ...... <br /> --------------I----------- --------------- -------- omplefe,in,.Duplicate).. <br /> - - -------------I--- --- --------------- - ---------F ;This Per-it Expires I Year From Date 1s;ued Date Issued ---- <br /> Applicafion 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 /> .ADDRESS AND LOCATIOI� <br /> OwnerJOB <br /> s Name--I'MI <br /> T--------------------------------------------- Phone---- <br /> Address------7.3 L _rf Z_2r ! <br /> ------------------------------------------------------------------ --------------- <br /> Contractor's Name----�1�1 <br /> V--------_­_--------------------- - --- -------- ---------------- ------------------------- Phone------------------------- <br /> Installation will serve: Residence E_ Apartment House 0 Commercial E] TrailerCourt E] Motel E) Other E] <br /> 'Number of living units: ___.I___ Number of bedrooms 3... Number of baths �-----,Lot size <br /> Water Supply. Public system ❑ Community system E-1 private D--Depfh to Water Table <br /> Character of soil to a depth of 3 feet: , Sand El Gravel [:] Sandy Loam El Clay Loam 0 Clay [I Adobe El---Hardpan El <br /> Previous Application Made:. (If yes, o. New,Conitrucfion: Yes o [I FHA/VA: Yes ❑ No <br /> TYPE:OF INSTALLATION AND .SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet <br /> Sepfic Tank:' Distance from nearest well:� -------Distance from foundation__ Material <br /> No. of compartments-" 2L 'Size --------------- <br /> --------- Liquid d,pth----7!K.................Capacity----ff.D 9 <br /> Disposal Field- Distance from. 'nearest well__4FP Distance from-founda" ticn---hh__ !-------Distance to nearest ]of line_ <br /> LJ Number of lines___--_ Z------------ <br /> ----------Length of each line---7L4 ----------------Width of french..... 'If <br /> I------------- ----------------------- <br /> Type of filter' material___-_/?6��Ujpih of fiIfer_material_!_jK___ _,-_____Total lengfh---./6--------------------------------- <br /> Seepage Pit: Distance to nearest wefl_/__40------------Distance from foundation_i©_(_J Distance to nearest [of line__ <br /> Number of pits._._____2---______Lining maferiial-___ <br /> I -----TU_4A'.--Size: Diameter____3 <br /> Cesspool: Distance frorri nearest well-----------------Distance from foundation------------------- Lining materia)--:-------------- <br /> ❑ S.# __D;,..- --r—_ — - <br /> Size: a"m e t;�--------------------------------------:Depth-----------------------------r------------- Liquid Capacity---------- --------- ---- ---OF4 <br /> Privy-.' Distance.from nearesf.well...... -----------------gals. <br /> -------------------- ----------------------Distance from nearest building---------------------------I-------------- <br /> - -- ------------------------------------------------------- ------------ <br /> EJ Distance to nearest lot line---------------- --------------------------- <br /> ------------ -- <br /> -- ------------ <br /> Remodeling and/or repairing (describe]_________________.___-______ <br /> - - <br /> ------------------------------------------------------------------ <br /> ----------•----------------------------------------------------------------------- <br /> ----------------------------------------------------------------a------------------------------ <br /> I ----------------------------------------- <br /> -----------r--------r---------------- ------------------••---------------------------------------------------------------a------------------------—-------------------------------------------------------------------------- <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 laws, and rules and regulations of the San Joaquin Local Health District. <br /> 1 - - 0 <br /> (Signed) I <br /> ------t-------------------I-------------------------------------------- ------------- ----------------------------------------------------------------------------(Owner and/or Contractor) <br /> By:J------------------------ i <br /> ----------------------------- -------------- - -- -------------- <br /> -----------*--------------------------------------------------------------------------------------------(Title]--------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, ' placed on reverse side). <br /> gs, efc., can be .4 <br /> fp <br /> FOR DEPARTMENT USE ONLY <br /> .............I-------------- <br /> APPLICATION ACCEPTED BY__4AU <br /> REVIEWED BY -------------- DATE--- ----------------------------- <br /> ATF <br /> BUILDING PERMIT ISSUED-------------- -------------------- ---------------------------------------------------------- DATE------------------------------------------------------ <br /> - ------------------------------------------------SM---------------------------- DATE <br /> Alterations and/or recommendations:______..__---_---- <br /> --------------------------------- ----------------------------------------- ----------------------------- ---------------------- ---------- <br /> ------------- ------- - ------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------- - ---- --- --- - --- ---- <br /> . ........ <br /> --------------------- --------------- --------------------------------------------------- <br /> ------------------------------ ----------------------- -1---------------------------------------- <br /> ---------------------------------------------- -----------------------------------------:.......... <br /> ------------------------------- - ----------- ------------ f <br /> ---- ------------------------- ------------------------------- ------------------------------------------------------------ ----------- --------------------- <br /> FINAL INSPECTION BY:-.-- <br /> ---------- --------------------------- Da'te------ ------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED S-S9 :aM 3-163 F. <br />