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FOR OFFICE USE: <br /> - ------------------------------------------------------ <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 herein described. <br /> This application is made in compliance with County Ordinance No 549. <br /> JOBADDRESS AND OCAT_ION-------o7o _ --- ----- _ --- ------- -------------------------------------------------------------------=--------------------- <br /> Owner's Nam -------- ----------------------------� ---- --- -------- -- - <br /> -•----------------------------------------I---------- -------------- Phone------------------------------------ <br /> Address_ •- ------ ---•------------ /� / <br /> ------- --- <br /> Contractor's Name------ _-• -____-- P--11 .------ <br /> ------ -- ---•• <br /> Installation will serve: Residence lj�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -/_ Number of bedrooms CP-- Number of baths __/ Lot size ____ ___- .'U------------------------- <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table_5Z ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 29-'Hardpan ❑ <br /> Previous Application Made: (If yes,date____________________) No ©-' New Construction: Yes ❑ No 20"'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 well_________________Distance from foundation-------------------Material-----------_---__..____.._____.__-__._.__.___.. (,J� <br /> ❑ No. of compartments--------------------------Size------------------ -------------Liquid depth-- -----------------------Capacity--------- ------------ ill <br /> Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line_______--____... <br /> ❑ Number of lines-----------------------------------Length of each line-----------------------__-----Width of trench-------------I--------------------- <br /> Type of filter material-------------------------Depth of filter material.__.-------------------Total length_-.-------.-____:._ ___ _________--_____ <br /> Seepage it: Distance to nearest well.-�)Q14_ .....Distanc om foundation_-__y�_______..Distan�e to nearest lot line__�_______.- <br /> Number of pits.- ------------Lining material r <br /> - - G . . Size: Diameter Depth-----.�,�------------------ <br /> r <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 lire--------- -------------- - -------------------------------- ------- ------------------------------------------ ------------------ <br /> Remodeling and/or repairing (describe):_. <br /> ------------------------------------ <br /> �-•��� C- . 'f r..-•------------------------------- <br /> ------------------------------------­------------------`-------------------------------------•------------------------------------------------------------------------------------------------------------- <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State la and rules and gulations of the Sa Joaquin Local Health District. <br /> ' ___a ._ wner and or Contractor <br /> Signed '��'�'�. - --""' - -- ------( / ) <br /> By:---------------------------------------------------- {Title) <br /> (Plot plan, showing size of lot, location of system in relation to wells, bui ings, etc., can ba pla ed on reverse si a}. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----------- ----------------------------------------------------- DATE------ �--- ------------------------- <br /> REVIEWEDBY------------------------------------------------------- ------ DATE----------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED-------------------------------------------------------------•---------------------------------------- DATE-- ------ -------------------- ------------------------------ <br /> Alterationsand/or recommendations:---------------------------------- -- --------------------------------------------------------•---------------------------------------------------•----------- <br /> -----------------------------------•---------------------------------- ---- --------------------------------------------------- --•-----------------------•-------•----- ------------------------------------- <br /> --------------------------------------------------------•-------------------------------------------•--------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------- -- -•------ -------------------------------------------------------------------------------------------------------------------------------- --- - -- ---------------------------- <br /> FINAL INSPECTION BY:------ Date----------- ------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ha:ellen Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stocklon,California Lodi, California Manteca,California Tracyr California <br />