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FOR OFFICE USE: <br /> -------------------__-__�'.-----_- �_..- APPLICATION FOR- SANITATION PERMIT Permit No. <br /> ----------- ------------ -- (Comple+e•in Duplicate) <br /> Date Issued <br /> ... ... This Permit Expires 1 Year From Date Issued <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 Ordina o. 5 <br /> JOB ADDRESS AND�UATON -"---------------------- Q-'�//�, <br /> Owner's Name ----------------------------------------- Phone ..L--L�..T---------©� <br /> Address--------------------------------_- ••------ ---------------------�--�--------•---------------------------- ---.-__. -------_-----..-.-__--- <br /> ------- <br /> �-------- -------------- <br /> Phone/UU �rContractor's Name------- <br /> Installation will serve: R enceApartment House [❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ t <br /> Number of living units: r r <br /> �. _____ Number of bedrooms _�. Number of baths _�..____ Lot size _.-�%.-E?..K__./..__��_____________________.__._ <br /> Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table 3-0- ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeN Hardpan ❑ <br /> Previous Application Made: {If yes,date----------------__. } No New Construction: Yes ❑ Norfz 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 /> Septic Tank: Distance from nearest weA --------Distance from foundation- -___.Material ------------------------------------------------ <br /> ❑ 4c54i#0! No. of compartments ----- --.-Size------------------- -----------Liquid ciep h------ -- ------- ------- Capacity------ --- ------- <br /> Disposal Field: Distance from nearest,well-.1Q.0_----Distance f m foundation._�:� ._-- istance to nearest lot line__'��_______.___ <br /> L <br /> um of a . .__ _ en of eat th of tren <br /> -------------- ------------------------ <br /> Type of filter ma erial__- epfih of filter mater al_( __Total ength--- - <br /> -------------------- --------------- <br /> r � •—r <br /> Seepage Pit: pis#ante to nearest well_-�QQ--______Distance tom undation__ _ ___-___.Distance fio nearest lot line-_.�_--- ------ <br /> Number of pits_ ining material--� --- Size: Diameter- .....X....Depth--- ---Z�-------------------- <br /> Cesspool: Distance from nearest well ----------------Distance from foundation---..-.---.----.- ..Lining material-----------.--------.-_._--_-_.-_-.-- <br /> ❑ Size: Diameter- -- --------- ----- -------.........Depth---------------- - ---------- ...... -------- Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well..---- ----_------------------------------------Distance from nearest building----------------------------------._-_--_. <br /> ❑ Distance to nearest lot line ------------- ---- ----------------------------------------•---------------------------------------------------------------------- <br /> Q C D <br /> Remodeling and/or repairing (describe):------ - -4 -- --------------------------------- <br /> --------------------------------------------------------- ----------------------------------------------------•---------------------------------------------------------------------- ----------------------------- <br /> --------- -------------:---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> 1 hereby certify tha ave prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws an rules and reg tions of the San Jo uin Local Health District. <br /> a <br /> (Signed)----------------- -- - ---- --- ------- --- A-- ---- ------- ------ - -- ------ - ------------- -- - (Owner and/or Contractor) <br /> $Y:------------------------- ---- - � -- -`'S-�-�� - -- - ------- --------- {Title------ - -- - - --- --... ..----------- <br /> (Plot plan, showing size o ot, location of system in re tion to wells, buildings, etc., can be place on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY___ <br /> --- - -- - ---- - ------ - ---- - ----------- -------------- DATE------ ----�-"�- -��-------- -- - <br /> - - --------------- <br /> REVIEWED BY------------------------- ---- --------------- ----- ----- -------- ------- ----------------------------- DATE <br /> BUILDING PERMIT ISSUED-------- -- ---------------------- ------------------ ------------------------- ------ DATE--------- ------------------- ------- <br /> Alterationsand/or recommendations------------------ ----- ---------------------- ---- ---•--•-----------------------•-----------•- -----------•-----------------•-—-------------------------------------------­----------------------- ----------------------------------------- --------------------------------------------------------------------------- <br /> ----------- ------- ------------- ---------------------------- -------------------- - ------- ----- ---------------- -----t------------------- <br /> FINAL INSPECTION BY: 140 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ma:elton Av. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lad!. California Manteca,California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br />