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FOR OFFICE USE: <br /> -------- --------------------------- ----------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. . Q .�--- <br /> ----------- <br /> (Complete in Duplicate) _ y Date Issued -' " <br /> This Permit Expires 1 Year From Date Issued <br /> Application is herelay made to the San Joaquin Local Health District for a permit to construct and install thy;work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION---.Ze? �--e-- ---------------------------------------------------------- --------------------------------------- <br /> Owner's Name__.-----A l�rylnl � {,��7r`ESQ- ------- Phone---------------------------•-------- t <br /> Address - QIJ -------------------------------------------------------------------------- ------------------------------------•-------- <br /> Contractor's Name------- ------- Phone----------------------------------- <br /> Installation will serve: ResidenceApartment House ❑ Commercial ❑ Trailer Court [j Motel ❑ Other ❑ <br /> Number of living units: j----- Number of bedrooms _1- Number of baths _/------ Lot size ----- -------------------------------- <br /> o <br /> Water Supply: Public systemCommunity system ElPrivate E] Depth to Water Table _� ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0—Fl-ardpan ❑ <br /> Previous Application Made: (!f yes,date-----------,-----_I No 111--, New Construction: Yes Ej--No ❑ FHA/VA: Yes ❑ No J�J-- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> r �^^� <br /> Septic Tank: Distance from nearest welL-!-�-----Distance from foundation,i(1__________.Material-------- <br /> �.4 .D --------• <br /> 2 No. of compartments_--�----------------Size------- ---Liquid depth__._--/'------_._____----.Capacity_._- <br /> Disposal Field: Distance from nearest well__----------Distance from foundation`-Zd--�-______.Distance to nearest lot lin .S- <br /> e--k ---/f----- <br /> Number of lines---I------------------------------Length of each line__9�_--------------------.Width of trench__Z_t-------------------------- <br /> Type of filter material_' tz-[,_ ....Depth of filter material__/$r_" Q <br /> ___----__.Total length A <br /> Seepage Pit: Distance to nearest weli_____-t-7�._._--Distance from foundation____.- istance to nearest lot line_ __:!____-__ <br /> Linin material__ J,CQ4_� .5ize: Diameter__ ------ ----Dept h.... <br /> -`-'-------------- <br /> Z�K Number of pits...._I_-------- g <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 /> Remodeling and/or repairing (describe)-------- -- ------- ---------•-------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------•----------------------------------------------------------------------------------------------------------------- <br /> ----------------------------•------------------------------------------------------- - --- <br /> --------- <br /> ------------------------------------ ------------------------- ------ ------------------------------------------------------------------------------------------------------------------ ----------------- <br /> 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, an rules and requbtions /If.hSan Joaquin Local Health District. <br /> ---------------------------------------------------------- <br /> (Signed) (Owner and/or Contractor) <br /> ---------------- r <br /> By:---------------------- - Title <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----------------- DATE------ ----� - �------------------------- <br /> REVIEWED BY-------------------------------- - ------------------ -------------------------------------- DATE--------------------------------------------- ------------ <br /> -- ------------------------------ - <br /> BUILDING PERMIT ISSUED---------------------------------- D;Tp""-e­ _-_­� <br /> Alterations and/or recommendations:----------- _-, ®� G� ------- -- <br /> - <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------- - <br /> --------------------------------------------------- <br /> -----------------------------------------------------­----------------------------------- ---------------------------------------------------------------------- <br /> ---- - ------------------------------------- -----------------em----------------- <br /> ----- -------------------- ---------------------------- • --------- <br /> FINAL INSPECTION BY:- --------- ---------- <br /> --------- Date--------- <br /> ------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1401 E.Ha:etion Ave. 300 West Oak Street 124 Sycamore Street 205 West 4th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> r.P.co. <br />