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FOROFFICE VSE <br /> - - ------ E- <br /> U______________________.__-._____-_- APPLICATION FOR SANITATION PERMIT Permit No. ..•.................>...._. <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, -......----•----..--------------- ` 'L <br /> ---------------------<....-------------------- <br /> ��// __ <br /> Owner's Name !� Phone <br /> ....---•------------------------ ---- <br /> `Z-72 <br /> --------------•---....-------------------------------------------------------------­ ----------------------------.._.-..-.-.-----. <br /> CO <br /> Contractor's Name ---------------• Phone <br /> ------• ----- ................................. <br /> Installation will serve: Residence ❑--`Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living.units: "__, Number of bedrooms__ .=Number of baths ---/--- Lot.size .____ �'- ,.�— <br /> Water Supply: Public system El e, <br /> Community system E] Private ❑Xepth to Water Table 3N. <br /> Character of soil to a depth of 3 feet: -Sand ❑ Greve) ❑ Sandy Loam Clay Loam'[] Clay E:] Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------___---) No ❑ New Construction: Yes U---Ko ❑ 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 /> Tank:— Distance from nearest well_________________Distance from foundation---------.---------.Material <br /> _______..__________.__________._____.-.-_______. <br /> Septic <br /> No. of compartments Size----••---------•----------------Liquid depth-------------------------Capacity----•------------------ <br /> Disposal Eield: Distance from nearest well_4�---.._.Distance from foundation.__Q___---------Distance to nearest lot -5 ___..... <br /> Number of lines--------------- ------------ Length of each line-----------��-`-------.Width of trench------- `j'.�--�_--- <br /> - ----- <br /> Type of filter materiaI____._�va------Depth of filter material---46---------------Total length----:---- -'p_______---------- <br /> f <br /> Seepage W <br /> ___ <br /> p ge Pit: Distance to nearest well_,,r�__.__._____Distance from fou dation___:_4.Q_________-Dista e earest lot li e______________ <br /> Number of pits._..__-/--_____ t____-_Lining material..______ .$ize: D':ameter__ - - �' epth__.._. --_-__- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------•.__..Lining material__--_..__-__--__________-_______---- <br /> ❑ Size: Diameter------------ Depth-------------- <br /> ---------=------------ L <br /> iquid Capacity--------=---------------- -gals. <br /> Privy: �f <br /> Distance from nearest well----------------------------------------------- <br /> from nearest building -------------- .� <br /> ❑ Distance to nearest lot line----------------------- ---------------------------------------------- <br /> Remodeling and/or repairing (describe):--------------------------------------------------------- . <br /> . t <br /> ______________________________________________________ r <br /> ----------------------------------------------------------------------------------------------------------------------------- <br /> r <br /> =------------------•-------------------•---------------------••--------------------- ------ j <br /> I hereby certify that I have prepaja <br /> "plication and that the work will be done in accordance with"San Joaquin County i <br /> ordinances, State laws, and rules and rof the S n Joaquin Local Health District. <br /> (Signed) ---------------------------- <br /> --------- - ------� (Owner and/or Contractor] <br /> ------------------------------------------------ <br /> BY:----•------ <br /> v J <br /> [ -- -------------'-----•-- Title <br /> )---------------------------------------- ------------------- --- <br /> ------------------------------- <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 <br /> BY ----_-:-DATF----- . -<r--------------------------------- <br /> BUILDING ... <br /> - -----•--- -- --- -- - --- = <br /> PERMIT ISSUED------ --}---- <br /> --- ----.. RATE <br /> Alterations and/or recommendations:------------------------------- <br /> ------------------------------------------------------------- <br /> - <br /> _-_-______.._____.y_________________________________________________________________________________________________________________________________ <br /> FINAL INSPECTION BY:.-y-- --..N;-- ------------------------------------- <br /> --- --:JOAQUIN <br /> - ---- %-=�1 --- Date-- j r�` r c? i <br /> SAN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> E9-9 REVIBED 9.89 r.P.Ca.2M 6.6EI <br />