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rUK Urrl(—t USL: <br /> -------------------- ----------------------------- ----- <br /> ----------- ----------­- <br /> --------------- ------------- ------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .. __!_. � <br /> ----------------- ----------- -------------- ------- [Complete in Duplicate] <br /> ---------------------------------- DateIssued <br /> --- ---�- -.-�- This Permit�Ex fres 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Healfh,District for a permit to construc. d insta ork herein descri6ed. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION---- -2- <br /> ----- - ------------------------- <br /> --- --------- ---------- ------------- <br /> ----------- ---------------- <br /> Owner's Name „ -------L�� _----------- �`` �U�'—U-� <br /> - - ------- -- - - --------------- Phone. -. <br /> --------------------- <br /> Address----------------- - --•�------`�_•-•------ ----- ----------- ---`�-------------•- <br /> . � _ � <br /> Contractor's Name__ %_ <br /> ------ ----- Phone. <br /> Installation will serve: Residence Apartment House p Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> ---------------- <br /> Number of living units: __�, Number of bedrooms__ Number of baths _/_--- Lot size -------- <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water TableRn ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel [❑ Sandy Loamk3--Clay Loam ❑ Clay ❑ Adobe ❑ 'Hardpan ❑ <br /> Previous Application Made: (If yes,dctte....................) No Tl/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.] <br /> mow. <br /> Septic an Distancefrom nearest well <br /> foundation --_-- -- _--._Material- <br /> ---------------------------------------------- <br /> No. of compartments _-Distance from---------------Size------------------------- -----Liquid depth--------------------------Capacity <br /> Disposal Field: Distance from nearest well---____----------Distance from foundation--------------------Distance to nearest lot line-.--___--_.-__--- <br /> ❑ Number of lines-----------------------------------Length of each line------------------------------Width of trench----------_-_ -- <br /> Type of filter material--------- <br /> --------------Depth of filter material----.-------------_---Total length------------------------------------------ <br /> Seepage it: Distance to nearest well-_z/ <br /> _ '.-.___Distance from foundation-__- ___.Distance Jto nearest lot line__ -'s -_____ <br /> Number of pits__________ ________Lining material ,__/e!i-A�: Diameter-_-_3. `-----Depth-___.. . <br /> Cesspool: Distance from nearest well-----------------Distance from foundation..._----------------Lining material__.- _--_----.____.--___---__ <br /> ❑ Size: Diameter.---._ __-- ------------------------ - <br /> Depth------------------------------ Liquid Capacity --------- � <br /> -----------gals. <br /> Privy: Distance from nearest well -------------------------------------Distance from nearest building❑ Distance to nearest lot line_________------------- -__------------ --- <br /> ------------------------------------------------------ <br /> ` <br /> Remodeling and/or repairing.(describe):------- <br /> ------------ -----------fir-- <br /> ----------- ------ ----- <br /> ------------- <br /> ------------ _ ,!L --------------------------------------------------------------------------------------------------------------------------------------------------------- <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, an rules and regulations of the/San Joaquin Local Health District. <br /> (Signed)---_-_ <br /> �- ------- ------- ----- `°�_ ---------.----.--(Owner and/or Contractor) <br /> �-BY:----------------------------------- -- - -- ---------------------------------------------- _ <br /> [Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse <br /> a <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --- - -- --------------------------------------- DATE-----�� .f_ --------REVIEWED BY = DATE-- <br /> BUILDING PERMIT ISSUED ---------------- DATE <br /> Alterations and/or recommendations:--------------_ <br /> --------------•-----------------------------------------------------------------------------------------------------. <br /> FINAL INSPECTION $Y:_-- --- -- --------_- Date_.. } - -- <br /> ; - - -- -- <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 .i Manteca,California <br /> Tracy,California <br /> F.P.CO. <br /> 4 <br />