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FOR OFFICE USE: 4. <br /> - ------------------ --------------- ------------ <br /> APPLICATION FOR SANITATION PERMIT Permit No. A..........!........ <br /> ------- ------------------------------------- ----i�----. (Complete in Duplicate) <br /> Date Issued ----------t............ <br /> --------------------- --- ---------------- ........ This Permit Expires 1 Year From Date lssuedA�427eoo <br /> .1I f <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 incompliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION__ -'-Q-";''.A_,*4-------- ----_-----I------- <br /> ...... ..... <br /> Owner's Name------ ------ ------------------- --- <br /> ------------------- ------- ---- ------------------------------- Phone---------••---------•-• <br /> 4� ---------------------- <br /> Address------------------ <br /> ---------- ------ - ------_---------- ------------------------------------------------1-1-------------------- <br /> -40e4 <br /> ---------------- <br /> le -------- ------------ Phone----------------- <br /> I...V--------------------------- <br /> Contractor's Name. <br /> Installation will serve: Residence 00 Apartment House [:1 Commercial E] Trailer Court [-] Motel El Other El <br /> I) - <br /> Number of living units: _1____ Number of bedrooms -A-.. Number of baths I___-. Lot size _14111­440o� ------------------------------------ <br /> 11 ---I-----------zr <br /> Water Supply: Public system [] Community system El Private V61 Depth to Water Table ?,0- ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam El Clay Loam [E Clay E] Adobe E] Hardpan 121 <br /> Previous Application Made.1 <br /> . (If yes,dote--------------------) No ❑ New Construction: Yes E] No E] FHA/VA; Yes Ej Noo <br /> TYPE OF INSTALLATION J�AND SPECIFICATIONS: <br /> �"-(No- sepfic-f a-A-6ir �esspool &_ riniffid if'pu-bli'c sewei­"i�a_ydiI66I6_­withiK 2001664--' <br /> 'IM <br /> Septic Tank: Distance from nearest well-----------------Distance from founclafion------------- ------Material------------------ ------------------------------ <br /> 0 No. of�hcompartments--------------------------Size--------------------------------Liquid clepth--------------------------Capacity----------------------- <br /> Disposal Field: D;stanA <br /> e from nearest well_________________Distance from foundation--------------------Distance to nearest lot line_--_____-________ <br /> ❑ NumbeT <br /> ine----------------- <br /> Numbe'T of lines_____________ ------------Length of each line------------------------------Width of trench._____._____,.,_______.._.___---._._ <br /> Type <br /> rench------------ ------------------- <br /> Type of filter material---- --------------------Depth of filter material-------------- --------Total length__________________________--_-__-____.. <br /> I' F.10-f <br /> Seepage Pit: Distance to nearest well-----/--..____Distance f'orn foundation---11P?l­­Distance to nearest lot line----------------- <br /> NumbJ of pits------ ----- - ------Lining maferial_,��_ ------------Size- biometer__- ---------DepthJ�.r--------------...... <br /> Cesspool: Distance from nearest well-----------------Distance from foundation----- ------------- Lining material_..____.._.________-_____________- oe <br /> F1 Size: Eamefer---- - --- :------------------- ------Depth---------------------------- ----------------------Liquid Capacity----------------------------gals. <br /> Privy: Distanc e from nearest well--------------------- ---------------------------Distance from nearest building_..._..._____--_--------_-.-----....._.._. <br /> F1Distance to nearest lot line----------------------------------------------- -------------------------------------------------------------------------------------------- <br /> Remodelingand/or repairing {describe):-------- ----------------•------------------•---------------------------------------------------------------------------------------------------------- <br /> -----------------------------I----------------!I---------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------- <br /> -- ------------------------------------------- ---------------------------------------------------------------------------------------------- ------------------------------------------------------------------------ <br /> ------------------------------------ -------A--------------------------------------------------------------------------------------------------------------------------------------------------------------------_-------- <br /> I hereby certify that 1�.haye 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. V <br /> (Signed) <br /> - - --- ----- --------------------------------------(Owner and/or Contractor} <br /> , <br /> B -----7 - --------- -----y - <br /> (Plot ----- - <br /> plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-Zle-A -------------------------------------------------- ------ DATE-----I'Y-CS--------------------------------- <br /> REVIEWEDBY----- --------------III----------------------------- --------------- ---- -------- --------------------------------------------- DATE---------- ------------------ ----------------------------- <br /> BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE---------------------------- -- <br /> - --------------------- <br /> Alterations and/or recommendations---------------- - - --- - -------------------- --------------------------------- ------------------------------------------- ---------------------- <br /> --------------------------------- ---------------------------- ------------------------- ----------------- ----------------------------------------------------------­--------------------------- ----------------------- <br /> ------------------------- ------------------- ----------- ------------- - ------ _------------------------------------------------- ---------- ------------------------------------------------------------------------------ <br /> ------------------------------------------------------------- - ------ --- --- ---- ---------- -----------------------------------------I------------------------------- ------------------------------------------------------ <br /> ---------- ------------------------------------------------------- ------- ---•--------------------------------------- ---------- - ----------------------------------------------------- <br /> FINAL INSPECTION BY -- ------------------------ Date-----/...... --- ---- - - ------------------------------------ <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 />