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FOR OFFICE USE: <br /> qjgj Tw­ 6g - - 13o <br /> . - ---------------------- ------------- <br /> ____ -__ _____________ ____________ -- APPLICATION FOR SANITATION PERMIT Permit No. .1. =. <br /> ------------- ---------------------------------- ----- (Complete-in Duplicate) _ <br /> Date Issued <br /> ---- .... I 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 /> JOB ADDRESS AN OCAT N l " l ..-G2z"-4=�[�E�ik= <br /> -------- -- - ----------------------------------------------------------------------- <br /> Owner's Name.. ... -- ....................................... ----------------­---------- Phone.................................... <br /> Address------- I_ --------------------------- T <br /> Contractor's Name......- ,a / S ----------------- --------------- Phone------............................. <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: Number of bedrooms .Z _ Number of baths----I... Lot size _.- :x.-! (-' <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------------.------ ) No ❑ New Construction: Yes ❑ No ET'_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 /> Septi Tan y. Distance from nearest well--11/ ----- <br /> Distance from foundation-------------------Material ------ ------------ --------_.___---.---. <br /> No. of compartments-__. -----------Liquid depth--------- ------- ------ Capacity---------------------.. <br /> Disposal Field: Distance from nearest well--- _..Distance from foundation.. .............Distance to nearest lot line---- <br /> [ G Number of lines---------I------.----------------Length of each line__A-i'--_---_--._.Width of trench.__y " <br /> --------------------- �s <br /> Type of filter material-_'1 u.4A----_--Depth of filter material_./,,Y.''__-____.___Total length----------�,-_�.�-------------...... <br /> � <br /> S u ry� • <br /> S Pit: Distance to nearest well------------------Distance from foundation_&.!..........Distance to nearest lot line.. jj........ <br /> Number of pits-_-.1---------------Lining material-- C,�____ Size: Dia meter_.9.`-K-_IQ..Depth---�a...`...................... <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 /> F-1 <br /> __._._..._.-- ._-------_.-_.❑ Distance to nearest lot line <br /> Remodeling and/or repairing (describe):---------- ---------- ----------------------------------------------------------------------------------------- ------- .._..-- ------------ <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, aq rules and regulations f the San Joaquin Local Health District. <br /> -- ----------------------- -----__---------_ .. ------------.(Owner and/or Contractor) <br /> (Signed) ...... -- - - <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 jt = - - - DATE-- -- <br /> REVIEWEDBY--------------------------------------------------------------------- ----------------- -------------------------------- DATE-------------------------------------... <br /> BUILDING PERMIT ISSUED---------- -------------------------------------------------------------------------- -------------- DATE <br /> Alterations and/or recommendations ____..__----__ ________'.--_..____.-_ -_.-.....___.- __ <br /> - ------------- -----•------ ------------ ............... _. . _ - � , <br /> ---•------------- -----•-----------------------------------------C-r---------- --- ------- ........ -------=----------------------------------. -G--------- ---- ----------------- --- ------------ -------- <br /> FINAL INSPECTION BY: _:. �1_�`�Q-- ----_. Date---m <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hasetton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi.California Manteca,California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br />