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FOR OFFICE USE- <br /> Permit <br /> SE: <br /> z�r `� Via'` 4 S� <br /> APPLICATION FOR SANITATION PERMIT Permit No. .__._ ----� , <br />--------------------- ----------------- ------ <br />----------------------------- <br /> ---- (Complete in Duplicate) <br /> Issued <br /> __ __ __- Date Issued <br /> ar --/ - <br /> This Permit Expires 1 YeFrom Date <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 in compliance with County Ordinance No. 549. e i <br /> --------------------------- <br /> JOB ADDRESS AND LOCATION____-- <br /> ---------------- - <br /> Phone----------------------- ------••---- <br /> Owner's Name-----0c � ------ <br /> J ,!� f - ----•------•----------------------- ----------------------------- --•--- <br /> Address-..----------------- -- - - --- one --- <br /> =S <br /> Contractor's Name---------- <br /> Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __J.- Number of bedrooms _�-- Number of baths __�.__ Lot size ____--'�_�-�a-°--------------- <br /> ----------------------------------- <br /> Water Supply: Public system dr-c--ommunity system ❑ Private ❑ Depth to Water Table 4.0- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay 6 Adobe ardpan ❑S,. <br /> Previous Application Made: (If yes,date___.___-._- 7 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 fee`) <br /> Septic Tank-. Distance from nearest well_'_-.----_Distance V ur atiogl ------4—Xp.-- -M teria-- ---_ Capacity__. CI i <br /> Size •3- - - -----Li uid de th ------- <br /> ❑/ No. of compartmenfs_..._o��- ---------- r ; <br /> Ag <br /> t lot <br /> Disposal Field: Distance from nearest well.. ' ------Distance from foundation_ --------------Distance t ofttrencesine_____- ---------- <br /> 2__ <br /> ---- <br /> Number of lines--------- ------------ - .---Length of each line_--�_------y ? o , <br /> Type of filter materiaL'___J`- /t-------Depth of filter material----l ------------Total length------------ -•---- <br /> Seepage Pit: Distance to nearest well -----Distance fou dation_��_____________ Distance to Deaths _,o e -r <br /> Ek" Number of pits- --__i�-----_r.Lining material_ _:_�J.fJ -Size: Diameter._._ p <br /> t <br /> Cesspool: Distance from nearest well____._.-_____._-Distance from foundation....................Lining material______------_..___.-.___-- ads. -J <br /> Size: Diameter------------ ------------- -----------Depth--------------------- ----------------------------Liquid Capacity----------------------------9 <br /> ❑ <br /> Privy: Distance from nearest well--------_------------------- _ _ <br /> --- --------__._Distance from nearest huilding---------------------------------------- <br /> ❑ Distance to nearest lot line----- -------------------- f1 <br /> I (ti <br /> Remodeling and/or repairing (describe):---------- ------------------,----- ----------- -------------------------- <br /> - ---------------------------- --- <br /> ----------------- <br /> ______________________________________________________________________________;___________.__________.___________ <br /> 4 _____•__ _..__--_ _____------------ <br /> __________ <br /> f ! here_ __._____--__._by certify that l 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 Saquin Local Health District. <br /> t -----._..-.(Owner and/or Contractor] <br /> ------ <br /> ------------ ---- ---- ------------- <br /> Title <br /> - -------------- ------------------- --- - <br /> By <br /> (Plot plan. showing size of lot, location of system in relation�to��ells, <br /> buildings, etc., can be placed on reverse si e . <br /> # FOR DEPARTMENT USE ONLY <br /> APPLICATION'ACCEPTED'BY- ---- ---------------------------- ----- <br /> DATE------ --�-- = <br /> --�` <br /> - --------------------------------------------- ----- <br /> -------- ---------•--- DATE----------------- ------------------------------------------ <br /> REVIEWED <br /> -•--- ------------------------- ------.. <br /> REVIEWED BY------------------------------------ -------- - <br /> - ---------------- - DATE---------------------------------------- <br /> ----------------------- <br /> --------------- ----------- ---------�------------------• <br /> BUILDING PERMIT ISSUED <br /> ------------------------ <br /> Alterations and/or recommend tions------------------- ---------- -- ---------------------------------------------- ----------------------------------------- <br /> Alterations <br /> ----- --------------- <br /> ---------------•------------- -------- = <br /> ------ .�`----- 0� -'------------------------------- - c�' <br /> l - �_Ork--`-�-- --" '------------- - ------------ <br /> ---------------------------- <br /> ---------------------------------- <br /> , <br /> Date---- -- - - <br /> FINAL INSPECTION BY:-r, ----. ----------------- ----------- - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ha:elton Ave. 300 Wesr Oak Street <br /> 124 Sycamore Street 205 West 91h Street <br /> Stockton,California <br /> Lodi,California Manteca,California Tracy,California <br />