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FOR OFFICE USE: <br /> --- -- - - - ----- ----------------------------------- -- <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> --------------------------------------------- ------ (Complete-in Duplicate) <br /> _..._._.. 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. �� �2- (� 06 <br /> JOB ADDRESS AND LOCA�JON '?'mac. __I"L_ __— -_ <br /> Owner's Name- .' -----• --- ----------- Phone------------------------------------ <br /> Address---.-.----- t. 1 1 `�� <br /> - ------------- -- ----------------------------------- ------------•-- --..........-------------------------------- <br /> Contractor's Name---------- - ------ ----- - ---------- ----------- ---- - ----- ........ --------------- ------ - ----------.. Phone-.--.- -----••----•---------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer- Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _ --_- Number of bedrooms 2... Number f baths- Lot size _____ ' <br /> Water Supply: Public system E] Community system E] Private Depth ater Table ------ _ ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel E] Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: {]f yes,date------------....... ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE: OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitfed if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-______________-Distance from foundation------------------.Material ------------ ----- .---------------_____._ W <br /> ❑ No. of compartments------- -------- - -__-Size--------- ------- - -----------Liquid depth--------- ------ --- --- Capacity------ -------------- <br /> Dispos Field: Distance from nearest well.----S. P-�___Distance from foundation__,��_--_.-__.Distance to nearest lot line__-5-.------ <br /> Number of lines ----------/--------------------Length of each line-- ----- _r--------- ----Width of french......sw---------.------.-------- <br /> Type of filter material-..----_X.,R........Depth of filter material--------/_.........Total length------41-Y ------------------------- <br /> t: Distance to nearest well...../_QP._______Distance from foundation---_Y-----------Distance to nearest lot line-_.S__--___.-- <br /> Number of pits--- ----I--------_Lining material------ .1Z--------- Size: f3mrrlet�f.� � ./a"._.___ <br /> Cesspool: Distance from nearest well ------------ ---Distance from founclafiion________-_-_-----_Lining material--_.___-._-__-_-----.--_--_____.___.- <br /> ❑ Size: Diameter- -- - --------- -- ------ -----Depth--------------------------------------- Liquid Capacity- -------------------------gals. <br /> Privy: Distance from nearest well.................................................Distance from nearest building------------------------------------------ <br /> Distance <br /> _..-_ ..--.._-_-_.___-_-__.._--_----.Distance to nearest lot line ----------------------------------------------•--------------------- <br /> Remodeling and/or repairing (describe):___ ...__ -_ <br /> ------------------------------ -----c :---- w------------- ----- -- <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, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed) -- —-- -------------------------------- ----- --------- ------- --- ---- -------- and/or <br /> B -- � - - ---- ------------ Title ----------------- -------------- n Contractor) <br /> (Plot plan, showing size of lot, location of system in relat' to wells, buildings, etc., can be placed on reverse side. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------ - ---------------------------------- --------------- DATE--A----- -- �_"'_�€f s ---- ----------------- <br /> REVIEWEDBY--------------------------------------------- ----- ------------------------------------------------------ ---- ------------- DATE------------------ <br /> BUILDING PERMIT ISSUED-------- -- ------ DATE--------------------------- <br /> Alterations and/or recommendations---------------------- ----------------------------- -----------...------------------------------------------ -----------------•------------z------------------- <br /> ----------------------------- ------ -------------------------- -- --------------------. -- ------------ -------------- -- •----------•--- <br /> FINAL INSPECTION BY:- - - ----------_- <br /> SAN <br /> ---------_SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h street <br /> Stockton,California Lodi. California Manteca,California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br />