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FOR OFFICE USE: <br /> ----------- -- ----------- ------------- APPLICATION FOR SANITATION PERMIT <br /> Permit No. .. -.. <br /> --------- -------------------------------- -------------- <br /> (Complete in Duplicate) Date issued - r > <br /> "---- ------- ---------- ----------------------------- This Permit Ex fres 1 Year From Date Issued <br /> --------------- <br /> Application is hereby made to the San Joaquin Local Health District for a permit to�nstr�uct and i the work herein descry e . <br /> This application is made in compliance with County Ordinance No. 549. 3 <br /> tL 771 'IV- Nr 4i G ,4Y FT rf r ,� '�"'------ �'"'�-----•----- <br /> J'0---fir e ,.fit}......--��--`----�1 ....... <br /> JOB ADDRESS AND L�ATION.---------- � - --- --------------------- ------• -- phone------------------------------------ <br /> Owner's Name---- <br /> � �e--- <br /> `i-1 <br /> & "<*---------------------------------------------------------------------------------------------- <br /> ti, <br /> Address------------------- <br /> Contractor's Name"---_-_-. Motel ❑ Other <br /> Installation will serve: Residence [� Apartment House 171 Co ❑ Trailer,Court ❑ <br /> .yam <br /> -------- <br /> Number of living units: ._-__. Number of bedrooms_._._ Number of baths ._.._ of size -----_______.-"--._-- --- <br /> Private Depth to Water Table -------- ft. <br /> Water Supply: Public system ❑ Community system ❑ Hardpan <br /> Character of soil to a depth of 3 feet: Sand F1 Gravel [I Sandy Loam [I Clay Loam [I Clay Adobe❑ j <br /> No [ --b <br /> Previous Application Made: (If yes,date--------------------) No T1 New Construction Yes ❑ No ❑ FHA/VA: Yes <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 /> Li Liquid de th ------- <br /> -Capacity--'-'-' <br /> ❑ No. of compartments--------------------------Size-------------- q P. <br /> Disposal field: Distance from nearest well- .--___Distance from foundation 1� --------Distance th ofttrenchest I---- line----------------- <br /> Number of lines-------------L---------.----------Length of each line7--_-- <br /> 5` 11 ----De Depth of filter material-----" y --------Total length--------'751----------- -------- <br /> tion <br /> --1- n <br /> Type of filter material___.____.__�_" _ --- <br /> Seep it: Distance to nearest well---- from foundation_____1_0_�__._._.Dista;ce to nearest loXline--- ----------- <br /> Number a# pits y� Lining material. �'�' Size: Diameter-----3-1-----------Depth--------- -------------------- � <br /> Cesspool: Distance from nearest well-----------------Distance from foundation.- ----------_Liquid Capacity------------------ --------gals. <br /> ❑ Size: Diameter-------------------------------------Dep <br /> --- - <br /> ------Distance from nearest building------------------------------------------ <br /> Privy: Distance from nearest WO----- ------------------- ---------------- <br /> ---------------------------------------------------- <br /> ----------- - <br /> ❑ Distance to nearest lot lire..--------------- ------ --------- -------- ------------------------------------------------------------ <br /> Remodeling and/or repairing (describe)_______________________ <br /> ------------------------------------------ <br /> ------------------- <br /> - - ----------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------- <br /> ------- - ----------- <br /> - -- <br /> ication an <br /> that <br /> 1 here-b-Stify lawsfhat I prepared this <br /> the SanJaaquinhLacalkHeall heDi trictn accordance with San Joaquin oun y <br /> ordinances, State <br /> ------------------------------------- r and/or Contractor) <br /> - --- ---------------- --- --- <br /> Tale <br /> By---------------- <br /> -------------------------Q- ---- -- <br /> (Plot plan. showing size of lot, location of system in lation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-.. _ <br /> DATE---- 1 -� <br /> ----- ---------- <br /> DATE------------------------------------------------------------ <br /> REVIEWED BY------------------------------- <br /> ---------------------------------___ ------- <br /> BUILDING PERMIT ISSUED__________________"---------- ..... <br /> Alterations and/or recommendations:------------------------------------------------------------------------------------------ <br /> ------------------- <br /> �� G7 <br /> FINAL INSPECTION BY: --__--- ------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street <br /> 124 sycamore Street 205 West 9th street <br /> Stockton,California <br /> Lodi,California Manteca,California Tracy,California <br /> F.P.CO. <br />