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F R OFFICE USE: <br /> `t�_41 ------- � D`r <br /> Y _ APPLICATION FOR SANITATION PERMIT <br /> Permit No. .... `- ` 7 <br /> ----- .--- -- <br /> '----------- ... <br /> -- <br /> ---- -- -- ,(Complete-in Duplicate) �i_______ <br /> S <br /> ______ _____ <br /> _ Date Issued-- ----_---_--------------- This Permit Expires 1 Year From Date Issued f <br /> Application is hereby made to the-San Joaquin Local Health District for a permit to construct and install the work herein descrbed. <br /> This application is made in compile ce with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION ------------- ------ 1 t' '-�.. ' ------------------------------------------------ <br /> -4 <br /> ------------___--------•----------------------- <br /> Owner's Name ` J -X-K?v- ��= Phone_._...- <br /> �i - <br /> �-5-ke ----a--' i t <br /> Address_________ - <br /> Contractor's Name 40 f( �-� ✓ - ------ Phone------ - <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ TrailerlCourt ❑ Motel ❑ Other ❑ <br /> Number of living units: __/- Number of bedrooms,.-,Number of baths __ __ Lot size -460___A`-.,/ -.-•d -------------- i <br /> Water Supply: Public system 2-1,ommunity system Q; Private-Lj " Depth to Water Table45;!p ft I <br /> Character of soil to a depth of 3,feet t Sand ❑ Gravel ❑ Sandy loam ❑ Clay Loam ❑i Clay ❑ Adobe Hardpan E]Previous Application Made: {If yes,date------------------- ) 'No ® `New Construction: Yes ❑ (No FHA/VA: Yes El No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well_________________Distance from foundation--____. ...........Material ------.--_--__--__-______-___.--_______ <br /> nf No. of compartments--` --------- ----Size--- ---------- - -----------Liquid .depth-- --- ----- Capacity---------------------- <br /> Disposal <br /> .--------------------- i <br /> Dis osal Fields Distance from nearest well...`_^�...Distance from foundation_ �07--_.`.Distance to nearest lot line::_e�y__._.._. <br /> k <br /> l Number. of fines__.___ _._.- Length of each line_�t�__--d-/O-_--.Width of trench: A---------------------------- <br /> - ---------Total length:'®-'o-------------------le <br /> • Type of filter materia/��� .Depth of filter material�� <br /> Seepage'Pit: Distance'to nearest well-.--7=—-------Distance f m fou dation_r _ ---------Dystance;o nearest lot line r-_-.-_ <br /> - Number of pits---/------- ---Lining material/r Size: -Diameter-_?.....Depthle-----------------.---- <br /> Cesspool: Distance from nearest well ----------------Distance from foundation----------------- -.Lining material................ .------ ----- ------- <br /> 0 Size: Diameter. f------ ---------------------Depth------------------------- -- ---- -- --------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from near est-weEl---------------- <br /> ---_------------------__---------Distance from nearest building_-...._---_____-_-_________.__..___--_. <br /> ❑ Distance to nearest lot line ----------- --------------------- <br /> Remodeling and o repairing (describe):_..-__----�4�-����-����------��-�-'�-� - <br /> ----------------------------------------------------- ------------ ----------I_ ---------------- -------- ---------- <br /> i h -- <br /> - - ------------------- - <br /> - - -------------------------------- -------------------------------------------------------------------------------------------------- - ------------------------------------------------------------- <br /> I <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, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)------------------------ `- --- l -- /� � (�er Contractor) <br /> ra <br /> By:-------------------------------- - -------------------- <br /> - {Ti+le) i <br /> (Plot plan, showing size of lot, location of cyst in relation to wells, buildings, etc.,can be placed on reverse side). <br /> r <br /> FOR DEPARTMENT USE ONLY �- <br /> APPLICATION ACCEPTED BY-­­-1e-'61V_-_- <br /> ------------------- - -------- ------------------------------------ DATE------------�� - - � �� - <br /> IREVIEWED BY----------------------------------- -------- --------------- ------ -------------------------- - - ------------------------- DATE-------- -------------•------------------------------- --- <br /> BUILDINGPERMIT ISSUED-------- --------- ---------------------------- ------------------------------------- -- ------------- DATE------------------ ---------------- ------------------------ <br /> Alterati ns an /or recommendations:. <br /> ------------------ -...................----------- ------------------ ----- -- -------------------------------------- ------ <br /> ---------------------- <br /> --------------------------------- ------ --------- ------------ ------ --------------------------- ----------------- --------------------- --- <br /> l Date------------ <br /> FNAL INSPECTION BY:.----------- ---------------------------- ------------ <br /> SAN <br /> ------ -SAN s <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> I <br /> 1601 E.Mazeltan Ave. .� 300 West Oak Street _ #` 124 Sycamore Street ,* 20.5 West 9th Street <br /> _ .rR , <br /> Stockton, California Lodi, California Manteca,California Tracy, California <br /> E.H.9 2M 1-67 Vanguard Press <br /> l <br />