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FOR OFFICE USE- <br /> 1'y - <br /> --------- �--- -------------1 ----- <br /> .- ��" ____ <br /> (Complete in Duplicate) <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------------------------ <br /> ----- -------- ------------------ <br /> I _-.... This`Permit Expires 1 Year From Date Issued Date Issued <br /> --- --------- ----------- <br /> -------------------- <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 /> JOBADDRESS AND LOCATION------------ ----a- -------- --------------------------------•---------------------------- <br /> Owner's Name------ t_-___. __ <br /> Phone.=f__� 7�5� <br /> Ad d ress--------------------------- <br /> 1�1, ._ F - �-� -------------------------------------------------------------------- ------------------- <br /> Contractor's Name________ __-. Phone-_, �/- 3/ �� <br /> Installation will serve: Residence gl---Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __/._ Number of bedrooms . " Number of baths ---/-" Lot size ------ S `-------------- <br /> aI Water Su PIY� Publics stem E�/CommunitY system Private ❑ Depth to Water TablePt. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay ❑ Adobe Hardpan ❑ <br /> ' Previous Application Made: (If yes,date--------------------1 No IJ' New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> e�pt c Tank: Distance from nearest well-----------------Distance from foundation____________:____.Material___.___-_-------__-._____-_-____-_-,-- ._-_---_. <br /> No. of compartments--------------------------Size..-•-------------------------Liquid deph____.____.- _-- -- -Capacity----------------------- <br /> Disposal <br /> ---------------------Disposal <br /> Field: Distance from nearest weII..C--- ------Distance from foundation__--P7 0--------Distance to nearest lot line____ __.._.___ <br /> [�� Number of lines_________._______ _____ _ Length of each [in e___ 4-__•3d._-____.Width of french___-_.- may" -O <br /> # Type of filter materiaL__Sr- .-Depth of filter material__/S-- _.-„ ._Total length__________________________________-_.” <br /> I <br /> Pit: Distance to nearest well-- �"-Distance m foundation_---d__d______.Distance to nearest lot line_-"------ <br /> Seepage ___-_ <br /> Number of pits".""�-.--. g -Size: Diameter-1-3-------_ <br /> -_-.___Linin material__. _.-.- "- <br /> -._._..Dept h ---- <br /> Cesspool: <br /> --,��---------------- 6 <br /> ❑ Size: Diameter, ------- - Depth----------------- - ------------------------------------.Lining material------------- ----------------- <br /> p ---------- ------------ Liquid Capacity----------------------------gals. <br /> Cess ool: Distance from nearest well_________________Distance from oun anon-_-.--_- <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 /> -------------------------------------------------------------- a <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, SAte laws, and rules a d regulations of the San Joaquin Local Health District. <br /> (Signed} v -- -- ---- ---- (Owner and/or Contractor) <br /> - n <br /> ------- -- - <br /> (Title)--- <br /> (Plo# plan, showing size of lot, location of system in relat' wells, buildings, etc., can be placed reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_-."_ DATE___-_ __ _ ._ <br /> --- ------------------------------ <br /> REVIEWEDBY------------------------------------ ------- ------------------- ------------- ---- -------------------------------------•--- DATE--------------------•--•--------------------•-------------- <br /> BUILDING PERMIT ISSUED------------------------ J --- DATE.`_ <br /> Alterations and/or recommendations: ----. /�-!_ --- --------- - --------------- -------------------------------------------------•- •----". <br /> - -------------- --------------------- <br /> ---------------"--•---------------------------------•-------------------------------------------------------- <br /> - ---------------------------------------------------•- --------------- --- <br /> ------------- ---------------------------------------------------------- <br /> ---------------------------------I-------­ --------------------- ------------------�x------------------------------- ------------------ -------- <br /> FINAL INSPECTION B ."-- ._-. �----- - �f <br /> ----- •- - - Date ------------- -- - ------ - ---------- - ------------- <br /> SAN JOA LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> I Slocklon,California Lodi,California Manteca,California Tracy,California r�C <br />