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FOR OFFICE USE: _ <br /> 2 <br /> ____ ---------------- ------ ................. . APPLICATION FOR SANITATION PERMIT Permit No.......... --------------- (Complete-in Duplicate) ' ' , e', <br /> t -- ----- This Permit Expires l 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 LO ATIO ----C---------------- <br /> Owner's Name__-- <br /> 2 •�a ---- ---- -------------------- ------------- Phone----- ---------------- <br /> Address----- .3 '2 --- = '!,Z <br /> Contractor's Name------- ___ t7� <br /> Phone <br /> Installation will serve: Residence ['Apartment House ❑ Commercial ❑ Trailer Court p Motel ❑ Other ❑ <br /> Number of living units: __ -)-- Number of bedrooms ____I___ Number of baths--./--- Lot size _.4G',-30.°_ <br /> ------------------------ <br /> Wate <br /> ---------------------- <br /> Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table 6_:Yft <br /> Character of sol! to a depth of 3 feet Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay - Adobe E�HElardpan <br /> Previous Application Made: (If yes,date__-- ..__._.. } No 211",New Construction: Yes E] No ETNA/VA: Yes ❑ No E <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic4: Distance from nearest well_________________Distance from fou dation____.._-._-----.,-. Material ............ <br /> E � No. of compartments--------------- <br /> Size -----Liquid depth <br /> Dispo� I FO Distance from nearest weft-------------__Distance from foundation_...................-Distance to nearest lot line----------------- R Number of lines ------ <br /> ---------- ---- ---------Length of each line.- ------------ ---------r---- Width.of trench <br /> Type of filter material__.- ----------------------- <br /> ' �r ---"------- <br /> ___________________Depth of filter material------------- ----�--.-Total length------------------------------------------ <br /> Seep e Pi Distance to nearest well ................._--Distance from foundation--------------------Distance to nearest lot line______--_______ <br /> Number of pits -- ------------------Lining material------------------ <br /> --- Size: Diameter----------------------- Depth-- ----------------------- <br /> Cesspool; <br /> -------------- -Cesspool: Distance from nearest well ------------ ---Distance from foundation__.... _,Lining material___________________________________ _ <br /> ❑ Size: Diameter- - ----------Depth----- ------------------------- ------------------Liquid Capacity----------- -- ---------• gals. <br /> Privy: Distance from nearest well--------------- -------- building` t <br /> ------------------------Distance from nearest. ----:_------------------------------_---_ <br /> ❑ Distance to nearest lot line _._____ t <br /> - - -------------- <br /> Remodeling and/or repairing (describe:-_�i1z �_- ,/ �e <br /> / -- - -------- ----------------- --------------------------'--•-------------------------------•---•----------- --.---- ---- ----- ' <br /> I -- _ _ <br /> -------------------- ------------------------------------------------------------------- ------------------------ -------------------------------------------- ------------------- --------- <br /> I hereby certify that I have prepared this application and that the work will 6e.done in accordance with San Joaquin County <br /> ordinances, State laws, and mules and regulations o the San Joaquin Local Health District, <br /> (Signed)--------------- <br /> --- ---- . . --------------- -(Owner and/or Contractor) <br /> gY� --------------------- ---------- ---------------- ------------------ ------------- -----(Title)--_---------------- ---- <br /> Title)-- ----------------- ---- I----- ------- --------- ------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY__._ ,- <br /> ---_r_ �•-_-_--- -_-- -______- - - <br /> ------- DATE---- -- <br /> REVIEWEDBY --------------------------- ......... ---------------=------------ ----------------- DATE <br /> UILDING PERMIT ISSUED-------- -- ----------- ----- - -- ----- ---------------------- DAE------- ' <br /> -- <br /> Alt rations and/or recommendations--------- ------ ------ - -- ---- - ---------- ---- ------------------------------------------- <br /> ---------------------- <br /> ----- ----------------------------- ----------------- - --- - ------- <br /> t <br /> ----- ----------------------- ---- - <br /> ------------ - - --- <br /> .---- ------ <br /> FINAL INSPECTION ----------------------------- Date....✓--t- - <br /> ------ --------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street <br /> 205 West 91h Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> E.H.92M 1-67 vanguard Press <br />