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FOR OFFICE USE: <br />____________________ __ _ .._ --- ---- APPLICATION FOR SANITATION PERMIT Permit No. <br /> --------------------------------------------------- (Complete in Duplicate) <br /> Date Issued --- <br /> -----------------------------------------------------------_________________________________________________________ � This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work here' descr ed. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND IOCATIO _ 1 --------F "21 ..- <br /> Owner's Name------ Ixl---Xdel sAir---------------=---- -------- Phone------------------------------------ <br /> Address------- <br /> ---------------------------------Address------- ��f --, --" -- t <br /> Contractor's Name----- ----------. Phone----------------------------------- <br /> Installation will serve: Residence [2'Apartment House ❑ Commercial"❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _/--- Number of bedrooms -_- Number of baths _.!e.-- Lot siz --------------------------------- <br /> Wafer <br /> ` l-- ----------------------------- --Water Supply: Public system ❑ Community system ❑ Private R?--17epth to Water Table 49WTt� <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ![ lay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: {1f yes,date New Construction% Yes-E];-No ka-"FHA/VA:,Yes-❑----No_J;4--. Y <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tankg Distance from nearest.well-----------------Distance from foundation-.--.____----.-e__.Material-_-______.----- ._.------------------------ <br /> .___.. <br /> No. of compartments--------- --Size------­----------------- .__Liquid depth---------- ---------------Capacity----------------------- <br /> D'isposed'-Field; Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line----------------- i <br /> GE f�E/!�i Number of lines-----------------------------------Length of each line.---------------------.__.--.Width of trench----------------------------------- <br /> Type of filter material________________________Depth of filter material____-_._____-_-.-_._Total length------------ ___.--..--------__.___.__- <br /> See age Ti . Distance to nearest well__ .'"r ___DistanCe from fondation_ --------Distance to nearest lot linew_�-.--.__ <br /> C Number of pits.....®_------------Lining material-, 6 __-.Size: Diameter-;Z, p._--_.__Depf4,;P <br /> Celspoo : F Distance from nearest well---------------- Distance from foundation-------------------.Lining material---------------------------- <br /> -____._�q'� <br /> El Size: Diameter-------------------------------------Depth-----•------------------------------ ----------°- Liquid CapacitY------------------ ---- 9a1�/j a <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest.building---._..----------------._____.._..._..... <br /> ❑ Distance.to nearest lot line---------------- ---------- --------- ------ - ------------------------------ ------------------------------------------•--- ------ <br /> Remodeling and/or repairing (describe)_______________ • <br /> w. 1 •i <br /> --------------------------------------------------------------------.._-..._-__-_-----_-__--__-.---.-_-.----_.__----____-_---__-_---------__-----_____,._-----.---___----------.._____ <br /> . --_____--_---_.___-----'------...._---- <br /> ------------------#___-__ --------------- ----------- --__-----_.._--_-_.-----_--_____-------.._--___-___._--__.----__._._-4____------____----_------_�"--�__�--_.________________`____L________ ____ _ <br /> I hereb certify that I have prepared this application and that the work will be done in accordance with <br /> y San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> F ~ <br /> �---(Si ned _— <br /> 9 }`�' == = = = = � _ � �,` = � = - = ( = or..Contractor)-� ...a <br /> i - ----- Title ---- - <br /> -- ----------------------------------------- -- <br /> )Piot plan, showing size of lot,.location of system ation to wells, buildings, etc., can 6e pl&Ea on'reverse side). �r <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .- -- - ----5-------- ----------------- ,J/j--------------------------- DATE . : ' <br /> REVIEWEDBY--------------------------------- ------ ------ ------------------------------ ------------------------------------------ DATE------- -= <br /> BUILDING PERMIT ISSUED--------------_------- ----------------------------------------------------------------------------- DATE.------------- ------------------- ------- <br /> Alterations and/or recommendations:-------------- ------------------------- ----------------------------------------------------------------------------- ------------------ ------------------- <br /> --------------- ----------- --------- ---- --------------------------------------------------------------------------•-----------------------------•---------------•---------------------- -------- ----------------- <br /> FINAL INSPECTION BY: . Date---,- .� - -- ---- - ---- ----------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street <br /> Stockton,California Lodi,California Manteca, California Tracy,California <br /> a r 4 <br /> F.P.E o. <br /> A <br />