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FOR OFFICE USE: <br /> --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. __-._../.. <br /> ------- -- --------­:­------------- ----------------- <br /> ------------- (Complete in Duplicate) <br /> -------- --- ---------------------I----------- Date Issued <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 he rein described. <br /> This application is made in compliance.-with County Ordinance-No. 549. <br /> --- --- ---------- <br /> JOB ADDRESS AND L CATI --------------------- <br /> ----------------- fthoe _� <br /> Owner's Name------------ ---- -- -------- ----- - ---- ---- ---------- -- --- ------Address------------ --------- ------ --------- -- ----- ----------------------- <br /> - --------------- - - <br /> Contractor's Name----- - ------------- - ------------- ------- -- ------ ........ ---------------------------------- Phone <br /> Installation will serve: esidence Apartment House 0. Commercial [] Trailer Court []I Motel El Other'o <br /> se <br /> Z Number of living units: Number of bedrooms _1___.. Number of baths -1----- Lot size ' A 7---,S- <br /> ------------------------------- <br /> Water Supply: Public system El Community system [I Private V Depth to Water Table - ----- <br /> Character of soil to a depth of 3 feet: Sand E] Gravel 0 Sandy Loam 0 Clay Loam ❑ Cla'y34 Adobe 0 Hardpan <br /> Previous Application Made: (If yes,date.................. -) NdkZ New Construction: Yes [I No F <br /> ZA/.VA:. Yes D NA <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> v 4 <br /> Septic Tank: Distance from nearest well_______.________Distance from foundation--------------------Q!Anal______________________________________________ <br /> c No. <br /> al------------------------------------------------- <br /> No. of compartments-----------------------..-Size--------------------------------Liquid depth---- I--------­---------Capacity----------------------- <br /> Disposal. Field: Distance from nearest well__,SV- -- <br /> - ------Distance from foundation--l-0...........Dist6;,nce to nearest lot <br /> L Number of Iines---- ------L_:---Deth of filter engthpof each'l.i ,�eney <br /> Type of filter material---IGL-0ek ,:_S6-'---Tr--------Width--- ' of trench.__, ------------------------ <br /> ma rial _Total length-----3-0------------------------------ <br /> " <br /> Seepage Pit: Distance tonear6sf..,VeII_.-------------------Disfamce from foundation___..:----I-------:bis,+a' nce to nearest lot line__._______- <br /> 171 Number of'pits___'___-.1 ------Lining material-----------------------Size: Diameter------- -----Dept h--------- ----------------------- <br /> Cesspool: Distance from nearest.,well-----------------Distance from founclafiian- - --------------,,,Lining material----- --------------------------------- <br /> Size: Diameter ---------------------- --------------�.­ __K * t� .,t---M----I---- --------- als. <br /> F-1 -----------Depth ----------------------------------Liquid Capacity 9 <br /> Privy: Distance from nearest well----------------------- -------------------------Distance from nearest building------------------------------------------*%, <br /> ElDistance to nearest lot -line.. --- -------------------------------- ------------------------------------------------------------------------------------------------------ <br /> Remodeling and/or repairing (describe)---- ---- --------------I ------------------------------------ <br /> ---------- - __ ----------------------------- <br /> --------------------------------------m----------------------------------- .9----------- <br /> ----------------------------------------------------------- ----------------------------------------------------------------------------------- - -----------------------------------------------I----------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------- ------------------ <br /> I hereby certify that I hav epared this appli tion and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rL id regulations he San Joaquin �gal Health District. <br /> 11 -------------------------------------- ------ ckq <br /> (Signed)------------------------ ---- -- ----- ....... (Owner and/or Contra <br /> By:. ---------- ----- - ------------- <br /> -_---------------- W-- ----- --- -- -- -- - - -- - -------------------------------------(Title)...... <br /> (Plot plan, showing size of lot, location of s stem in relation to wells, buildings, etc., can be plat on reverse -side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.... 1,M_ ----------- -------------------------------------------------- DATE----3=104_—)---------------------------- <br /> REVIEWEDBY- ----------=------------------------ ----------------------------- ---------------------------------------------------------- DATE------------------------- -------- ----•-------------------- <br /> BUILDINGPERMIT ISSUED------------------------------ --------------------------------------------------- DATE------------------------------------------------- ----------- <br /> Alterationsand/or recommendations:------------------ --- - ----------------------------- ------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------- --------------------------------------------------------- - ------------------------------------------------------- --------------------------------------------------------------- <br /> ----------------------- ---------------------------------------------:------------­1-------------------------------------------------------------------I---------------------------------------------------------------- <br /> -------------------------------------- ------------------------------------- - --------------------------- ------------------------------------- ------------------------------------------- --------------------------------- <br /> ------------------------ -------------------------- <br /> ------ ---------- ------------ -------- ---------------------------------------- -- ---------------------------- -- ------ -------------------------- <br /> S—le7—(--7 <br /> FINAL INSPECTION BY:..----/ ..A,-/ W --------- ----- Date---------------------I--------------------- - - ---------------­­------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />