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FOR OFFICE USE: I R. <br /> ------- - ---------------------------------- <br /> ----------------­--- ...... ------------- --- APPLICATION FOR SANITATION PERMIT /Permit No. <br /> -i (Complete-in Duplicate) <br /> -------:I'--- 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 LOCA710A/ <br /> C_` <br /> Owners Name.. -�l /,F -------� --- -------.- Phone--------------------- <br /> Address <br /> -- - <br /> Address ....--- <br /> c ------------•------------ - -1- ----------------------------------------------- ------------------------------ ! <br /> Contractor's Name-------------- r----- - --- ---- -- --- ------------ ---- Phone------------------------ ------ <br /> Installation <br /> - --Installation will serve: Reside ce Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units. _ _._ Number of bedrooms __Number of baths./.._ Lot size <br /> - --------------•----------- r <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water.Table ------ - ft <br /> Character of soil to a depth oIf 3 feet- Sand ❑ Gravel E] Sandy Loam �ay Loam L] Clay L] Adobe❑ Hardpan ❑ t <br /> Previous Application Made: (if yes date__....- J No ❑ New Construction; Yes ❑ No ❑ FHA/VA: Yes ❑ No `t <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: i <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 /> ❑ No. of compartments..__-_--- ----------Size--------_------------- ------Liquid depth--------- ----- -------.CapacitY------------- -------- <br /> pisposa Field: Distance from nearest well <br /> -__......-..---_Distance from foundation---le----------Distance to nearest lot line_------------ <br /> Number of lines -''_--I------------- ` ---Length'of each line---------.j`---�---------.Width of trench::.2--./----------------------- j <br /> Type of filter material'.'___S-R__t-------Depth-of-filter material__.-----�!_.q _.....Total length------s4'P__.`------------------------- I <br /> t: Distance:to nearest well--.__ oe.......-_Distance frooghoundaton�:_/ v-�_------Distance to nearest lot line__.-F.... I <br /> Number of pits.-- ----1-----------Lining material---------------- --- size. e+ar_;n"-A -�--Depth-._--/P./ f <br /> Cesspool: Distance from nearest well ---------------- Distance.'from foundation... ---- ---.---- ..Lining maferial .._-__--_-.- <br /> ❑ Size: Diameter_ __ __ ________ <br /> Depth,.---- Liquid Capacity gals. <br /> Privy: Distance from nearest well------------ __.----------------.......__-...-.Distance from nearest building-----------------------------_ <br /> Distance to nearest lot fine ------------------------_ <br /> ----------- ------------------------------ <br /> Remodelin and/or re ainn �'{describe): - ' ------- <br /> •-----_----9--- ----------� 1-- gf: ..------ --- - .. <br /> ------------------------------- i ------- <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 /> I i <br /> (Signed) I - - - -------------------------------------------- and/or Contractor) <br /> 01 <br /> B :--------- _ ^ ,.-w..- ----- ----------- <br /> B, (Title) <br /> (Plot plan, showing size of lot,aocation of system in relation to wells, buildings; a+c., can be placed an <br /> L,. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY <br /> REVIEWEDBY-------------------------- -- ------------ -------- - ----------- ----------- --------------------------- -- ._ DATE------------- -------- <br /> BUILDING PERMIT ISSUED ---.I'-- ----------------------- ------------------------ --------------------------------------- - DATE-------- ------------------ ------ --------- <br /> Alterations and/or recommendations:-_-_.......................................... ... ................ . <br /> �I <br /> ................................................. ........--.._-_.__.--__---..._-._.-_-.....---._.._.__..__...------------------------------------ ................ <br /> ..___-._____-.....______ f <br /> ................................... <br /> 9 <br /> I! <br /> _____________________ __- .-_...___-_---.__..-.-.__.._......__ -----------------__.....__._. --------.-------------------------..--------....______..._.-_........._ <br /> FINAL INSPECTION BY:_ _ __ . <br /> I--------r----------- Dater 7 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazeltan Ave. II 300 West Oak Street 124 Sycamore Street 205 West 9th Street l <br /> Stockton,California Lodi. California Manteca,California <br /> y Tracy,California <br /> EA 9 2M 1-67 Vanguard Press <br /> i <br />