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�\ Permit No.APPLICATION FOR'SANITATION PERMIT -rl-��-�-�- <br /> (Complete in Duplicate) J <br /> � , bate Issued ---fP/� <br /> A <br /> `cation is herebymade to the San Joaquin Local Health District for a perm' to construct and install the work herein described. <br /> _Thisapplicatiori is made in compliance with County Ordm nce No. 549. <br /> 0 € JOB ADDRESS L CA <br /> *:u TION (1®`'4 ----- - -------------------------------------------- --- <br /> --- -------- <br /> Owners Name- ' .-- -� ----- <br /> Ph one <br /> —: e :} <br /> Address-----------, --•..- rC --- --- -- -------------- _ <br /> --- - <br /> Contractor's Name----------------- - ----------------------- ------------- <br /> ---------- -- -- - --------------- ------ <br /> ---- Phone - -.�- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ railer Court ❑ Motel Other ❑ <br /> Number of living units: ___ - Number of bedrooms e __- Number of baths -_/-- Lot size ------------------- <br /> Water Supply: Public fsy temX­Community system-❑ "Private❑' Depth'to-Wafer Table ft. <br /> i {� <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam W Clay ❑ Adobe Hardpan ❑ `-'may <br /> ' FHA/ No ❑ <br /> Previous Application Made: Yes ❑ Na ❑ New Construction: Yes ❑ No ❑ VA: Yes ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank.or cesspool permitted if public sewer is available within 200 f et.) <br /> f <br /> peptic Tank: Distance from nearest well----------------- <br /> Distance from foundation <br /> __-'--------------,_Material_---__""-______--_--_______-----_____"-----__""... <br /> No' of compartments------- "------Size--------------------------------Liquid depth,--------- ---------------Capacity---------------------- <br /> [ 4 <br /> DisposlIild: 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--------------_------Total length-------------------line----------------- <br /> Seepage Pit: Dis ance #o nearest well,- <br /> Seepage -----Distance from f ndatio _ Distance to nearest lot line - <br /> ��"(' Number of pits.-----/------------ Lining material---Size: DiVI --------.Depth-_- ., --------- --------- <br /> Cesspool: Distance from nearest well---------------_Distance from foundation.. i-------___---,-.Lining material--.-_-_____-------"----_-___--___-_-. <br /> Size: Diamefer-------------------------------------Depth------------------------------------ -------------- <br /> ElLiquid Capacity gals. <br /> Distance .from nearest building -- <br /> ,'rivy: Distance from nearest well-----.------------------------------- a <br /> ❑ Distance to nearest lot line---------------------------------------------- <br /> i -- <br /> Remodel nil/or repairing [describe):_____ <br /> --------- <br /> .� ----------- <br /> --------- <br /> ------- ---------------- ------- ---------------------•----- ------------------------ <br /> ------------------------- <br /> --------------------- ---------- <br /> - " - -pp---'=-------------•---------------------- -----.---.----------------=----------------------------------------------------- <br /> ------`--- ---------- - ------------------- -- ----- -- - <br /> I hereby certify that I have prepared this a lication;and thatthe work will be done in accordance with San Joaquin County, <br /> ordinances, State laws, and rulal�a regulati OV4 an Jo rain Local Health District. <br /> ' -------- ------------------ (Owner an /or Contractor) <br /> (Signed)--- ------------------(Tit <br /> Ie ----------------- <br /> By..--- -- <br /> ------ <br /> - -- -• ---T---- - - ,--------- --------------- ------- -' <br /> (Plot plan, s wig siz of of, lop tion o{ system in rel Ition to wells, buildings, etc., can be paced an re ers�, e). <br /> FOR DEPARTMENT USE ONLY <br /> r <br /> APPLICATION ACCEPTED BY------------------ ------------ " ----- ------------------- -- DATE---- ---------------- -" --------- -- ------ <br /> ---- - --- ------- -------- <br /> e cap <br /> f <br /> REVIEWED 13Y-------------�=-------------------------------- ------ ----- -- -} - ------ --------------- ----------------- --- DATE----- -------------------- <br /> ATE---- --------------•--•--- ------------ ----- ----- <br /> BUILDING PERMIT ISSUED----------------------- - - ; - - ------------------------------------------- DATE ------------ <br /> Alterations and/or'-recommendations------------------ --- --------------------------------•--------------- <br /> - ------ - -- ----------- <br /> I <br /> ----------------------- <br /> --------------------------- <br /> --------------- <br /> -------------------------- <br /> -- - -----------------•--------- ------- ---------------- <br /> ---------- <br /> -- <br /> - --------------------------- <br /> - <br /> _ ---------------------- <br /> --- <br /> - <br /> ---- -----.---- <br /> ? <br /> - ----------------------- ------ ---- <br /> FINAL INSPECTION BY:.. - Date +" - -------------------- --- -------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> r <br /> ( ES-9-211 . Revised 1.57 F.P.CO. <br />