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FOR OFFICE USE: <br /> ------ ---------------------------- --------- - APPLICATION FOR SANITATION PERMIT l <br /> ----- --------------- <br /> ---- <br /> ------------ i <br /> - (Complete-in Duplicate) Date Issued crZ Jr (, <br /> -� - �-- - -- --� ------------ <br /> -- -� --�-•y-- . - . - This Permit Expires 1.Year From Date Issued r ,r <br /> -_-...---------------- _ <br /> Applion is hereMLOCATION-J <br /> San Joaquin Local Health District for a permit to construct and install the work herein des�r;bed. <br /> This ai�tio 's enee with�C�yr�ty,,. anc N549. e <br /> 74VDDRESS <br /> ��-A _ ----- ... Phone----••--------------•--------------- rnr__. -------- <br /> Address <br /> ----- <br /> Owner's Name_"__-- <br /> Address--------------/J? -�-�----•--- r <br /> Contractor's Name____.--------- ---•�+ - ""- <br /> --------- -•---- Phone.----- -•----•--------------------- <br /> Installation will serve: Residence ®/'Apartment House ❑ Commercial E] Trailer Court [I Motel El Other ❑ <br /> s.�." Number of baths '7 <br /> --- Lot size <br /> Number of living units: __/�-- Number of bedrooms / <br /> Water Supply- Public system ❑ Community system El Private Depth to Water Table �o- ft <br /> Clay Loam ❑ Clay ❑ Adobe �-lardpan ❑ V <br /> 11 <br /> Character of soil to a depth of 3 feet' Sand ❑ Gravel ❑ Sandy Loam ❑ y No FHA/VA: Yes [ — No ❑ <br /> Naw Construction: Yes ® , ❑ <br /> Previous Application Made: (If yes,date-_---------------- ) No. } <br /> TYPE.OF INSTALLATION AND SPECIFICATIONS: ' <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f <br /> Septic Tank: Distance from nearest well... -" "...--Distance from foundation--/ ierial <br /> /� Ca acit � ��-•-- <br /> WOO* No. of compartments.-__a�L Size r--T--�J� Liquid depoth__ /�----. -. ..-- P Y <br /> f <br /> d�______._.Distance to nearest lot line_-"�-..---. <br /> Disposal Field: Distance from nearest well -.- Length of rom e each line--ati«o�n � -Width of trench_.;-`P------------------------- <br /> ®/ -----_---- <br /> Number of lines"__.0 g �" `` <br /> Type of filter materia�. ,F� Depth of filter materiaL._ �'�r ----Total length_ s _ --------- ---------- <br /> �- Distance fr rrl foundation___._ ------Dist5n e to nearest lot line_.'"---------- <br /> dw <br /> Seepage Pit: Distance to nearest well_.:f'��- -- -- De }h- / x;k <br /> .. ----------- material`_ ._e Size: Diameter__" ." --g --.---- P <br /> Number of pits___/� g s <br /> Cesspool: Distance from nearest well ,.______..____Distance from foundation.............. .. . Linin material_----- _.__ _---______------------- <br /> ac <br /> Liquid Capacity gals.' <br /> ❑ Size: Diameter- -- -------------- - --------- ----Depth------------ - ------------- - ------- -------- q P Y <br /> Privy: Distance from nearest well .............. ..-:- - <br /> -----..Distance from nearest building <br /> ------------ -- ------- --•---------------------- ------------------------ -------- ------------ <br /> Distance to nearest lot line ...___.____.- .. - <br /> Remodelin and/or repairing (describe): - -- - �-�..--s.�--�' �---��� ----� ----"�F-�'-�-��---- --=------ -.,_---------------------•--- <br /> g / P g � <br /> ------- --•-------------=----•------------------------------------------------ --------------------------------------------------------------- <br /> - ----------------------------------------------------------------------- ----------------------- = = <br /> 1 hereby certify that I have prepared this application and that the work will.be done-inwaccordance:;with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. Fl <br /> -- Contractor) <br /> ® = •------ ------------------- ( <br /> St ned � � - - <br /> -- 1 -------------------- (T;tle) ..... ... -- <br /> (Plot plan, showing size of lot, location of syste relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------------ -' <br /> DATE------- <br /> - -� ------------------------- <br /> - <br /> 3 DATE <br /> REVIEWEDrBY--.---------------------------------- ----- -- DATI <br /> - <br /> BUILDING PERMIT,,. --.------------- <br /> -------------------- --- <br /> ------- ------------ <br /> _, <br /> Alterations and/or recommendations:_...._.......... ............................ . . <br /> -------------- <br /> -- -- ---- <br /> ------------ ---------- <br /> - - <br /> ------- ---------- ------------------ <br /> r - <br /> ....................--------------_... '•. <br /> Date------ <br /> FINAL INSPECTION <br /> ----------- --� -- . . <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1401 E.Hazelton Ave. <br /> 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,Califarnla <br /> Lodi, California Manteca,California Tracy,California <br /> r E.H.9 2M 1.67 Vanguard Press <br />