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FOR OFFICE USE: <br /> J <br /> �� . ; . S Gam-- 03 <br /> I - --- � ' ........ <br /> APPLICATION FOR SANITATION PERMIT Permit No. .. <br /> ------ ------------------- _------- --------- (Complete-in Duplicate) l <br /> ------------------------ This Permit Expires 1 Year From Date Issued Date Issued <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. <br /> JOB ADDRESS AND LOCATION--- -1--l-701_--- <br /> JJ-�-- <br /> Owner's Name Phone--- <br /> 7Q <br /> ------ ------ --- - - •------- •------- <br /> Address-------------------------------------- " ----•-•-- -------------------------------•-•----•--- ------------------------------------------------ --- ------------------------------------ <br /> Contractor's <br /> -- - ----------------------•----- <br /> Contractor's Name........... <br /> ,O ............... Phone_----• ----------•--__--------•- <br /> Installation will serve: Residence [�J' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __1__-- Number of bedrooms -------- Number of baths-------- Lot size ----- --- ------- --------- -------------------------------_ <br /> I Water Supply: Public system ❑ Community system ❑ Private Z�J­Depth to Water Table ...... _ ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0--Hardpan ❑ <br /> Previous Application Made: [If yes,date_- .--------------- ) No Cr New Construction: Yes ❑ No aFHA/VA Yes,K No <br /> ae <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: C.EZ <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septi T�ank�tj Distance from nearest well-----------------Distance from foundation-------------------Material.-_--_-______-__._._____-________._____.__. <br /> No. of compartments-- ------- ------Size-------------------- ----- -----Liquid depth--------- ---- -- --------Capacity�� .. <br /> DEsposal FieEd: y 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-------------------------Depth of filter material-------------___-------Tota! length_-__--__--_____________________-__-_ <br /> Seepage Pit: Disfance to nearest well'VP '+---------Distance from foundation--S_------___ Distance to nearest lot <br /> [� <br /> li`e-------_-_--__--_ <br /> � ------------------Number of pits _ -1----------------Lining fI , Dep - O <br /> \ <br /> Cesspool: Distance from nearest well ----------------Distance from foundation-_--.------------ lining material__._.._______.______-_________-_--_--. <br /> ❑ Size: Diameter- -- --------- -- - - -----Y---- Depth- ,...--- --- --------- -------- ------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well------------------------------------.............Distance from nearest building--------------------..__,__............... <br /> ❑ Distance to nearest lot line ---------------------------- - ' - <br /> -Remodeling and/or repairing (describe}:....__y if' •!``�!,�� �v!� � <br /> I ----- ------------------------------------------------------------- <br /> 5 <br /> k -------------------------- -- -- ------------------------------------------------------f------------------------------------------------------------------------------------------------------------------- ------ <br /> I hereby certify t/hat [ ve prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, a ru and re la ' ns of the San Joaquin Local Health District. <br /> (Signed) ___Owner and/or Contractor <br /> B ----------------- ------------------------------ - -...... <br /> - - ..... <br /> - --------------- Title----------------- ----------------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> :t <br /> FOR DEPARTMENT.,USE ONLY <br /> APPLICATION ACCEPTED BY =` # ° -- '------------------------------- DATE------ <br /> --------- -------------- <br /> REVIEWED BY--------------------- ------------------------ _-------=---------------- -- ------------------------------------------------- DATE-------- <br /> ------------ --------------------------------- <br /> BUILDINGPERMIT ISSUED-------- -- ----------------------=--------- } ......_------------------------------------- DATE-------------------------------------------------------- - -- <br /> Aiterafions d/o recommen afi ns---------------- ----------- -- <br /> ` --------- --- -------------------- ------------------------ ----.. <br /> ---- <br /> __________________________------------______------------------------_------------___________________________________________________________________________________________________________________________________________ <br /> FINALINSPECTION BY:-- ----- -------------------------- - -----•----- Date------ ----------------------------------=_--- -_ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hasolton Ave. 300 West Oak Street i 24 sycamore Street 205 West 9th Street <br /> Stockton,California Lodi. California Manteca, California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br /> V f <br />