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FOR OFFICE USE: � ! <br /> -------------------- - ---"--------------------------- -- APPLICATION FOR SANITATION PERMIT <br /> Permit No. <br /> ------------- <br /> --- ---�- � ----"�--"" _ _ (Complete in Duplicate) ,✓ <br /> Date Issued --�->- <br /> ---------------- 2--- -_ ----------- <br /> =. <br /> ------.--" This Permit Ex fres 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Hdealth DlNoc for a permit to construct and install the work herein descrbe ., � <br /> This application Is made in compliance `with County �} <br /> aa�� -- ------ <br /> ------------ <br /> JOB ADDRESS AND LOCATIOG_-- _ Phone---.--_-""------------------------- <br /> -------------- <br /> --------------- ---- <br /> Owner's Name---- --•- -----••--------- <br /> Address-----------•------------------• .. � -�-----•-------.". Phone--------------- ---------- <br /> C Name_ _ <br /> ;;�entou Hse C] Commercial ❑ Trailer Court ElMotel ElOther <br /> Installation will serve: Resident `f�—� �— '�L�a-�.""_.- <br /> Number of living units. .__! Number of bedrooms --_Number of baths ---I-"" Lot size --------- ---- <br /> Private Depth to Water Table -------- ft. .^ <br /> Water Supply: Public system ❑ Community system ❑ Adobe❑ Hardpan ❑ <br /> er of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Ciay ❑ <br /> Character No ❑ FHA/VA: Ye`s ❑ No <br /> Application Made: (If yes,date-------------- -----) No ❑ New Construction: Yes ❑ <br /> Previous App' r <br /> ' TYPE OF INSTALLATION AND SPECIFICATIONS: ` . <br /> [No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> f <br /> Septic T nk: Distance from nearest well-�a"-------Distanc��e from i° cS�Liquid depth Maf lal ----- Capacity.. 1-0�2_ <br /> No. of compartments_...---. -----------Size- <br /> - O <br /> / / Distance to nearest lot�ir�e-�-------:-- <br /> Distance from Field: Disfiance from nearest welL__+� ---Distance from foundation�.��- - -__:Width of trench."._'�------------------------ <br /> Number of lines---------------- ------------Length of each line---_ - -- --------------- <br /> Pe <br /> -"------------ ' <br /> Type of filter material----- __ i-------Depth of filter material----__�_ ----'--- <br /> 17 --Total length_".-_ -.�— <br /> Distance from foundation---_•_--"""--_.---.Distance to nearest lot line-_.-------"-._ __ <br /> Seepage Pit: Distance to nearest well---------------- ---------------------- <br /> Number <br /> Number of pits- ------- ------ ----Lining materia <br /> ---------�--- '--�--Size: Diameter-_-:_r------ �----- -Depth ----�,- -------------- -�--- .. <br /> ❑ nearest well-----------------Distance from foundation__- ----'Lining`'rnaterial_ _.--_...--:.-------- <br /> Cesspool: Distance from -Li Liquid Capacity-.-._- ""----------------•gals• <br /> Size: Diameter"_,-�---- ------ - ---- ------------Depth----- ----- ------- - - - ----------------- g <br /> ❑ Distance from nearest building"-----------------=--------------------- <br /> _�. <br /> Privy: Distance.from nearest yell.'---------- ----------------------- <br /> ------------------------------------------- <br /> Distance <br /> ----------- <br /> ------------------------------------------ <br /> --- ------- - --- ------- ----- <br /> ❑ Distance to nearest 4ofi line_____________________ __ „ <br /> ------------------------------------ ---------------------­_ <br /> = <br /> Remodeling and/or repairing (describe):---- -- <br /> Q <br /> k ------r--- ------------- - ------------------- <br /> ----------------- - <br /> . <br /> ------------------------ ------ <br /> - ,.� <br /> ----------- <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, a ru s and regulations of the San Joaquin Local Health District. <br /> j <br /> - ----------------------------- <br /> and/or Contractor) <br /> (Signe ----------- = --- - <br /> ) ------)Title)------------------------------------- ----� <br /> By:------------------- <br /> - - <br /> [Plot plan, showing size of lot, location of system in relation to wells, buildi ,.etc., can be plated on reverse si e. <br /> FOR DEPARTMENT USE ONLY <br /> I <br /> < <br /> DATE----7r._.�_4._�----------------------- <br /> APPLICATION ACCEPTED By - - <br /> ---------------------- <br /> ------- ------- ------ DATE------ ----------------------------------------------------- <br /> REVIEWED13Y-- -------------------------------------- ----- - - DAT ------------------------------------------------;#----------- <br /> tBUILDING PERMIT ISSUED------------------------------------------------------------- -- ------------------------------•--------------------- <br /> - ------------------------------------- <br /> Alterations and/or recammen attons:----------------____.--"- ------------ _-- <br /> --------------------------- <br /> -------------- <br /> - ---.._--- <br /> ---- <br /> -- Date". - 7-3�--7-- �• ------- ------------------------------ <br /> FINAL INSPECTION BY'erE <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street <br /> 124 Sycamore Street 205 West 9th Street <br /> Lodi,California <br /> Manteca,California Tracy,California <br /> Stockton,California <br /> ES 9 REVISED B-59 3M 3-'83 F-P-CO. <br />