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FOROFFICE USE; - _— <br /> ------------- <br /> -------------------------- ----------.------ ----------- APPLICATION FOR SANITATION PERMIT Permit No. .1.-- � <br /> -------- -- -------- ----------------------- ------------ r (Complete in Duplicate) <br /> --------- This Permit Ex fres 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal; the work herein described. <br /> This application is made in compliance with County Ordinance `No. 549. <br /> JOB ADDRESS AND LOCATION------6_�Q_11,0e -- /--: _A_.s_��-�.--sT_,atc--- �rf�l� 11-11�iOecl_. <br /> Owner's Name V A .IF .Q-,S--T- �---•------•------ -- ---------- Phone <br /> Address -'� D 5 1I�f/Gv��-/.� ----D'ev---------77 � <br /> Contractor's Name iC�/s ------------------------------------------------------- --•--- Phone___,444;--- <br /> Y�1,�rA <br /> Installation will serve. Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> ' Number of living units: ---I---- Number of bedrooms ---:?'_ Number of baths � Lot size -----------loo- <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table-5 ___ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [9—Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------- ----) No [' New Construction: Yes ❑ No Er"-F-HANA: Yes ❑ No E�-/ <br /> I TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> _ <br /> i Septic Tank: Distance from nearest well_.__.. _ ____Distance from foundation ------�" "Ma}eria`I--------------------- <br /> "" " ""^` •-+�.� <br /> ------ --------------------------- <br />` No: of compartments --------Size---------- -------._._Liquid depth------------------------capacity----------------------- <br /> Disposal Field: Distance from nearest well-./,AlDistance from f and ti n_ __. ____-. Distance to nearest lot line___ ? <br /> /� -- = �-�a _ <br /> Number of lines--------- - <br /> ------ ---------------Length of each line_--" - -----------.Width of trench------ - /-------------- <br /> Type of filter material._4/V4A_'___Depth of filter mat eriaI.__,lef_1'-"I-------- otal length-------6 <br /> C <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation-_-.---------------.Distance to nearest lot lineN <br /> El Number of pits- ------------------Lining material-----------------------Size: Diameter------------------------Depth-------------------------------- <br /> Cesspool: Distance from nea .___.-_._._______ <br /> rest-well___-_______..___Distance from foundation--------------------Lining material_--------------❑ Sze: Diameter =- ----- Depth ------ --------------Liquid Capacity------- -------- ------ -gals. <br /> :., <br /> Privy: Distance from nearest Tell---------------------------------- --------------Distance from nearest building <br /> ❑ Distance to nearest lot line <br /> - ----------------------------------------- <br /> Remodeling and/or repairing (describe}:__.._- �' �------ <br /> --------------•------------------------------------ <br /> ------------------------------------------------------------------------------------------ - <br /> ------------------------------------------------ <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 /> r <br /> (Signed)--------------------------------- �0-nerd/or Contractor) <br /> 8Y� -- ------• ------ --- - - ----------------------------------------------- ` <br /> - - ------ ----- -- -------- (Title)------- <br />+� of plan, showing size o lot, location of sy 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 /> UILDING PERMIT ISSUED-------------------------------- ------ DATE <br /> Alterations and/or recommendations:------------------ <br /> ----------------------------------------------------------------------------- <br /> ------- ----------------- ------------------- ----------- •------:-- <br /> -------------------------------------I---------------------------------------------------"------------------------------- <br /> ------------- - -------- ------------------------- <br /> ---------------------------------- -------------- ---- <br /> FINAL INSPECTION BY---------------------- C Date_-------�-----�- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street <br /> 205 West 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> F.P.0 O. <br />