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FOR OFFICE USE: <br /> --------------- -- -----------------< ----a-- <br /> $APPLICATION FOR SANITATION PERMIT Permit <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. <br /> JOB ADDRESS AND LOCATION_I s'l- r-I "r-- ---Q` -r-- Yf -- J'--1�• <br /> Owner's Name. ® -`�` - ----------._ Phone- <br /> Address------------- a .'/r7-r�X �� --- --�'----------------------- ----------�------------------------------- <br /> --------� Phone._=ITQ �I!`fj- <br /> Contractor's Name-------• - -- - - -------------------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -1----- Number of bedrooms _- Number of baths..j----- Lot size _ - -_.�_� ' <br /> Water Supply: Public system Community systen Private X Depth to Water Table as ft Zo <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe X Hardpan ❑ <br /> Previous Application Made: (If yes,date_---...... ------ } No..R. New Construction: Yes ❑ NoML_.FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 4 <br /> . --_...(NN�.sepfic tank or cesspool permitted,if public sewer.is available within.200 feet.) <br /> Septic Tank: Distance from nearest well------------_-Distance from foundation. ........ ....... Material _ ...__.---------------------------------- <br /> . <br /> ❑,5)([51Wj; No. of compartments-_- ...................Size------------------ --- -------Liquid dep>h-------- ------- ------.-Capacity------------------- - <br /> Disposal Field: Distance from neares well__&V_ .-Distance from foundation. —�"` <br /> ��____.._.Distance to nearest lot line__._______._ <br /> Number of iines ----------Length of each line__ ----7--- Width of trench.._ !r----- <br /> Type of filter material_ _ _______________Depth of filter material__._,�._�..........Total length------ <br /> . --- _------------------ <br /> Seepage Pit: Distance to nearest well---------- dation <br /> ______________Distance from foun -------------------- to nearest lot line----------------- <br /> 3 [] Number of pits---------------------Lining material......-__............. Size: Diameter-----------------.-.---Depth .._.------------------ <br /> Cesspool: Distance from nearest well ................Distance from foundation----------------- Lining material_.___-_--------__.________________- <br /> 1 t Size: Diameter- -- - ----- ----- ---------------De th------ -------- ----- ------ - --- ------- -------Liquid Capacity gals. <br /> Privy: Distance from nearest welt-------------------------------------------------Distance from nearest buiiding------------------------------------------ <br /> ElDistance to nearest lot line --- = - ---------------------- <br /> Remodeling and/or repairing (describe):_ / •. ----------------------------------------•--- <br /> -------------------- ------------------------------------------------------------------------------------ -----------------­•--•------ -------- ------------------------------------------------------ <br /> I <br /> ---------- ------------ ----------- --- -----------------------------------------------•-•------------------------------------------------------------------------------------------------------------------------------ <br /> I hereby certify that 1 have ared this application and that the wor ill be done in accordance with San Joaquin County <br /> ordinances, State laws, and rut s a d regulatie�ns of San Jo quin Loc ealth District. <br /> --- ----- -------------------- Owner and/or Contractor <br /> (Signed)----------- / <br /> Bye......----------------- -------- +-------- -----------------------(Title)-- <br /> (Plot plan, showing`sixe of-I " , location o sy em in relati'o'n to'wells;buildings;etc.;cart bepjc on reverse <br /> FOR DEP R MENTUSE ONLY <br /> APPLICATION ACCEPTED - ---- --------- ---------u-r--------------------------------- DATE ` ------------- --- <br /> REVIEWEDBY---------------------------- --- ------ - --------------------------- -------------------------------------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED-------- -------- ----------------------------------- --------------------------------------------. DATE------------------ -------- -- ----- ----------- <br /> Alterations and/or recommendations--------------- - - ------ -- -------------------- ---------------------------------------------------------- <br /> ---------------------------------- <br /> FINAL INSPECTION -------------- <br /> Date <br /> SAN <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Lodi. California Manteca,California Trac <br /> Stockton, California Yr California <br /> E.H-9 2M 1-67 Vanguard Press <br /> s- <br />