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T <br /> FOR OFFICE USE: <br /> - ----- -- r Permit No. 3.5- <br /> --------------------------------- <br /> ----------------- APPLICATION FOR SANITATION PERMIT <br /> -------------- ------------ ----------------------------- <br /> ----------------------- (Complete in Duplicate) <br /> - - -------------------- ------------------------------- <br /> ------ <br /> ----- - Date Issued ---�-�-------` <br /> -------------------------- This Permit Expires 1 Year From Date Issued <br /> Applica#ian is hereby made to;tha San Joaquin Lova! Health District for a permit to con trust and <br /> /install the wor he�r{e�in�escribed. <br /> This application is made in compliance with County Ordinance No. 549. IV <br /> �'T" `� <br /> JOB ADDRESS AN OCA IONI.-___ -:.-- --- "` j <br /> iI Phone------------------------------------ <br /> Owner's <br /> Name------------ t ---------- ----- - ---- - <br /> Address-_ <br /> ��! ------- -------- ---- ---- <br /> ' - ------------- - ---------- Phone.. <br /> Contractors Name------ --•-- •----- ------ <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: .' --- Number of bedrooms'._ Number of baths __�---- Lot size ________________________._- <br /> -- --- ------•-------------- <br /> Water Supply: Public system ❑ Community system ElPrivate pth to ater Table -------- ft. E <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel [_1Sandy Loam Eff Clay Loam E] Clay ElAdobe ❑ Hardpan E] <br /> Previous Application Made: (If yes,date---- ---------------) No ❑ ' New Construction: Yes ❑ No ❑ 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.) x - <br /> Septic ank: Distance from nearest well----- 4_'__Distance from foundation__.�_a__ --------Material------- 1`'�-*---------- <br /> r Capacity-, <br /> Li uid de th- ------------------- ° � <br /> No. of comparfiments-------------------------- - - -- -- G � R <br /> Dispos Field: Distance from nearest well'__.5Vr. Distance from foundation ___.-----•Distance to nearest lot <br /> 'v ---------.Width of trench. st ---------------------- <br /> Number of lines___.___-1--------- "'-°Length of each /-C-/--------------- <br /> g p <br /> -_ P - ---Total length <br />� Type of filter material-_--.___."�:�-.De fli"of filter matenaL._-__-�__ <br /> Seepage Pit: Distance to nearest well______-_____-______Distance from foundation------------______.Distance to nearest lot line_____--_________ <br /> ❑ Number of pits--- ------------------Lining material---------- ------------Size: Diameter---------------- ----Depth------------------------------- <br /> Cesspool: Distance from nearest well_________________Distance from foundation ---------- -_____.Lining material------------------------------------ <br /> El <br /> -------- - ---- <br /> ❑ Size: Diameter------ --------------------------- ---Depth--------------------------------------------------- Liquid Capacity- - ------------------------9 <br />! Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---.----- --------------------------- - -. <br /> -------------------- <br /> Distance to nearest of ine------------------------------------------ ----------------'-----'- <br /> ---- - --- <br /> Remodeling and/or re airin descriUe ------------ ------- ------------ ------------ ------•--------- <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 Count <br /> ordinances. Statelaws and rules and regulations of the San Joaquin Local Health District. <br /> �{Aweer and/or Contractor) <br /> - - ----------------- --- ----- <br /> { g [Title) ------------ <br /> .---- ------ ------------------------------------ <br /> (Plot plan, showing size of lot, location of s stem in r ',on to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---� --------------------------- <br /> ------ ---------------------------------------------- DATE---2-_-13-14.7---------­--------------- <br /> REVIEWED BY------- ------------------ ---- ------------------------------------------------ ---------- ----------------------------- <br /> DATE------------•------•--------------------------------------- <br /> � BUILDING PERMIT ISSUED ---------------------------- <br /> ----------------------- DATE------------------------------------------------------------ <br /> Alterations <br /> -- --------------------------------------.._.Alterations and/or recommendations:----------------- ---------- ----------- ---------------•------------------------•-------------------------------- <br /> ---------------------------------------- <br /> ----------------------------------------------------- ---------------------------- <br /> - <br /> ------------ -- <br /> --- - ---------- --- -- - <br /> --------------------------------------------------------------------- <br /> FINAL INSPECTION BY:��! ��� --------- ----- <br /> Date__ .�-f _ ----- ------------- -------------- --------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1661 E.Ha:ellon Avt. 340 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California <br /> Lodi,California Manteca,California Tracy,California <br /> F.P.0 O. <br /> ' <br /> I <br />