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FOR OFFICE USE: ` i <br /> �r <br /> _ APPLICATION FOR SANITATION PERMIT -- --------- <br /> --- ---------------------- <br /> Permit No. <br /> -- ._..!- ----- <br /> t <br /> ----- -------------- <br /> [Complete in Duplicate) <br /> - ... Date Issued <br /> ------------ <br /> _____ +-------------- - -----_----------.-_ This Permit Expires 1 Year From Date Issued /-7*7— 4&f0-03 <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install t work er in described. <br /> ' _This application is made in compliance with County.Ordinance No. 549. <br /> JOB ADDRESS AND CATION <br /> m -- - `'r� <br /> I Owner's Ne .— <br /> --------------- ------------ ---------------------- Phone <br /> _ ...------•---------------•-•----------------- ..... -------- <br /> Address <br /> ----------- ------ <br /> i Contractor's Name___________ <br /> - - •- <br /> ------- -------------------- -------- ---------- Phone... <br /> Installation will serve: Residence FrApartment House [I Commercial ❑­ Trailer Court ❑ Motel ❑ O#her ❑ <br /> k `� <br /> ` �___ Number of'K-6t <br /> Lot size --------------------------------------- <br /> Number of living units: __ _.___;Number of.bedroams. - <br /> ' <br /> Water Supply: Public system C] Community system ❑ Privatepth'to Water Table,0�ft. <br /> i <br /> Character of soil to a depth:of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam [IClay ❑ Adobe❑ Hardpan ❑ <br /> . ..- 1.r p <br /> Previous Application Made: {If yes,date--------____________1 No [ New Construction: 'Yes ❑ FHA/VA: Yes [ �lo ❑ Q <br /> !. TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f <br /> Se tic Tank: 'Distance from nearest_well___ __.__Distancre t rom foundation--.�1. -----Mahal__ ------ - - - <br /> ' } e-s�`o-__r—U E--- Liquid depth - ----------Capacit _ -/__. �o <br /> f of compartments_ .__ .--___.___.._.-_Siz _ <br /> �p h��----------- <br /> -_ Distance from founda ' n.. -__ -- Distance to nearest Int line__ __________ _ <br /> 1 xWidth of trench_- <br /> field: NiumaE7er ofol neseare wells Length of each line__�3�__------'Jy ----- ------- <br /> T e of filter material epth of filter .material----_fT-_----_.Total length__.f --------------------------- <br /> Type.' <br /> -—-------------------- <br /> f YP . l - <br /> Seage Pit: Distance to nearest well------- ___ ------ Distance from foundation___________________Distance to nearest lot line______;_-_.__... <br /> 'Number of pits----------------------Lining material------ ---- ---------- Size: Diameter------------ --- ----..Depth--------- --------------------- <br /> lcsfr , T <br /> r Cesspool: Distance from neargst�e✓ell-,.:- :_ ._:___..Distance.from,foundation.-_-__._.__.__ .Lining-material_._. _------------------- <br /> ❑ Siie Diameter-------- -----------------------------Depth--------------------------- ----------------------Liquid Capacity-_------------- --- --gals. <br /> PrivDistance fromfnearest well--___.__.._------------------ -- ---Distance from.nearest building---_-_._-------______--------------------. <br /> y:. <br /> ! ❑ Distance to nearestilot line-------------- - -------------------------------- ------- <br /> i � y ------ <br /> -------./lll��---- '��� <br /> Remodeling and/or�.repairing (describe)------------- - ----------- ---------------- ------------- - - - - -- -. <br /> ----------------- <br /> ----'--------------= --- � - <br /> .� :: - � -- <br /> - <br /> I hereby certify`that I have prepay this application and that the work will be one in accordance with San Joaquin County <br /> ordinances, State laws; qd.rules and regulations of the San,Joaquin Local Health District. <br /> tc, ° , �or Contractor) <br /> , <br /> ed - <br /> (Sign ) �, 4 l <br /> By:----------- <br /> -= ----------------- -----(Title)- ----------- <br /> (Plot plan, showing size of lot, location of_syst, _relat.ionto..w`e11s, buildings, etc., can be placed on reverse.side). <br /> l <br /> { DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY <br /> DATE <br /> --.-------,/< � ------------ <br /> ------------------- <br /> - -- ------- ----------- <br /> REVIEWED BY----------------- --- DATE <br /> BUILDING PERMIT•ISSUED---------------------------- ------------------------------------------ - DATE <br /> Alterations and/or recommendations ----- ------------------------------------••--------•- <br /> ----------•-------•-----------•-------------------------------•---------- <br /> ---------------------------------------------------------------------- <br /> i <br /> ----— ----------------------- -------------- ---------------- --------- -------------------------- <br /> ---------- ---- <br /> FINAL INSPECTION BY:.------- - ^- - ------- Date----- ------ �r/--12a,_3 --------------------- <br /> USAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 4Y <br /> 1601 E.Haselion Ave. 5`340 West Oak Street' s ' ,,1.24 sicam6re Street ; 205 West 9th Street <br /> ' S Trac California <br /> Stockton California Lodi,California Manteca,California Y, <br /> Stockton, <br /> FS 9 r2EVi96O a_S9 3M 3•'63 F.P.C13. <br /> T <br />