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FOR OFFICE USE: <br /> ----------- ---------- --- --------------------- -- <br /> APPLICATION FOR SANITATION PERMIT Permit No. .�� _ . <br /> ----- -- -------- - (Complete-in Duplicate) —,3 a_�l <br /> --- ----------------------- ----------------- � - . This Permit Expires 1 Year From <br /> Date Issued .�------------------ <br /> 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. 'p f <br /> "« O <br /> JOB ADDRESS AND LOCATION-���--.YA--- �f-- -- fes''-../ ----------- --� � � '' <br /> Owner's Name...._..__ __�.��� .� :.s. �_ <br /> --- - ---------------- -------- --------------------------------- --------- Phone__.-. ----------------------------- <br /> Address ..�� ._i3 � .17f e-0�-----------------------------------•-------- ------ ----------- -------- ' <br /> Contractor's Name------ - '--------------------- ------- --------------------------------------------. Phone------ ---------------------------- <br /> Installation will serve: Residence [Apartment House [❑ Commercial ❑ Trailer Court [❑ Motel ❑ Other ❑ <br /> Number of living units: .__ Number of bedrooms A-_ Number of baths _.e--- Lot size ------------------ <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table/ ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date_----- - --,_ ___. 1 No P' New Construction: Yes ❑ No B—FHA/VA: Yes ❑ No S4—, <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 -_-� _-.--_....._----._--_-._-._..__.__. <br /> /5 .�f of No. of compartments - Size-------------=------ -----------Liquid depth--------- --- --- --------Capacity----------------------- 1'i <br /> Disposal Field: Distance from nearest well-Zd.?A....Distance from foundation_Ze__-.------Distance to nearest lot line-_07-._....... <br /> Vryf Number of lines -------/------ Length of each line__-,?_0'd0&._ ..........Width of trench_.x--- ---------------------- <br /> Type of filter materialo_1"'0r* Depth of filter materia -_._..-Total <br /> Seepage Pit: Distance to nearest well......................Distance from foundation__--.-_- --------Distance to nearest lot line--.-------------- <br /> El Number of pits----:"----------- --Lining material.--------------------- Size: Diameter-----------------------Dept h--------------------_----------- <br /> Cesspool: Distance from nearest well ................Distance from foundation___-------------..Lining material------------------------------------- <br /> 0 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):...-------- ------ 1"d, �_�_--------------------------- ------------------------------------------------- <br /> ---------------­------------- ------------------ ------------------------------------------------------ ----- <br /> -•--------•-------------------------------- . ------- <br /> ------------- ------------ ----------------------------------------------------•------------- ------ '---------------------------------------------------------------------- - -------------- -- --- <br /> I 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, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)----------------------------- -------- -------- ---- -------------- --------------------------------------(QWmep-emffor Contractor) <br /> By:__------------ V-- _,--(Title){r� —------------ <br />"�"�[Plot plplan show ng size of lot,.location of syste relation+ye sem,buildings, etc., can be placed on reverse side). <br /> _. FORD AR/TMENT USE ONLY <br /> APPLICATION ACCEPTED BY----. ------- ----------- -------------------------------- ---------- DATE ' �� ----------------------- s <br /> REVIEWEDBY--------------------------------------------- --------------------------'---------------------------------------------------- DATE--.-.-------------------------------------------- <br /> BUILDINGPERMIT ISSUED----------------------------- ---------------------------------------------------------------------. DATE-------------------------- -- ------------------------------ <br /> Alterations and/or recommendations:---- ---------------- -- - --- -----••----- - --------------------------- ---- ------..-----------------------------------------------_ <br /> ---------------------•-------- ------------------------------------ -- ---------------- -- ---------------------------------------------------- ---------=- - ----- <br /> •------------------------= <br /> ------------------------------------------- ------- ------------- . - - -- - ------- -------- ---------------------------------------------------- ---- _----------------- � <br /> ------ .................. ---- -------- ----............. ---- --- -- ------- ------------- - ----- -- ------ ------ <br /> FINAL INSPECTIO --- ----- Date............. = �77-A�------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> k <br /> 1601 E.Hasetton Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street <br /> Stockton,California Codi. California Manteca, California Tracy,California <br /> E.K.9 2M 1-67 Vanguard Press <br /> f <br />