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FOR OFFICE USE: <br /> PPLIC TION FOR SANITATION PERMIT Permit No. . a.J?. � <br /> ------- ---- ­----------- ----------------- -------- (Complete•in Duplicate) <br /> Date Issued ./('___._�__�7 <br /> ------------------ ____ ___________ -----....------- This Permit Expires 1 Year From Date Issued <br /> \?", <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 LOC TION. . os----------------------------- <br /> Owner's Name___ �'�" <br /> ---l.�ll ------- •-Z. Phone <br /> A <br /> Address ....-- - 7 -V------y�--- - ---------- ------------- '.----------------•.---•--•----------------------------------- <br /> . <br /> Contractor's Name------------------------------------------------------------------------------------------- ---------------------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence M Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: I ----- Number of bedrooms _ ' _ Number of baths --I Lot size ----------------------- <br /> Water Supply: Public system ❑ Community system ❑ Private Pp Depth to Water Table2-D_ ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam [ Clay Loam El Clay F] Adobe❑ Hardpan E]Previous Application Made: (If yes,date___________________ ) No ❑ New Construction: Yes ❑ No ❑ 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---r _".__Distance from foundation_� b.........Material ------------------ <br /> No, of compartments-_2---_------------- 1-006—'__Liquid depth---------- ----.Capacity?1170----------- <br /> Disposal Field: Distance from nearest well.S-'a..-----Distance from foundation./Q-----------Distance to nearest lot line_..._._..._ <br /> Number of lines------/___. ------.--Length of each line__/_-----_.-__--.-.Width of trench–A-Y`---------- <br /> Type <br /> Type of filter material f,/��..A___-______-Depth of filter material-I., '_____________Total length---/---__ --__-__---_._-___--_. <br /> Seepage Pit: Distance to nearest well-----_-------__-------Distance from foundation....................Distance to nearest lot line---__.--_---__--. <br /> ❑ Number of pits____.-------------- Lining material---------------------- Size: Diameter-----------------_-__Depth-----.__--__._._--__---___--- <br /> Cesspool: Distance from nearest well --_--_-___.-_-_Distance from foundation_________________ __Lining material..----------------------------------- <br /> F1 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):------------------------------------------------------------------------------------------------ --------------------------- -- <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 aAd regulations of the San Joaquin Local Health District. <br /> (Signed) --------------------------•----- ----------- ------.(Owner and/or Contractor) <br /> 49131(✓✓=---•...............•-•------------•---------- ---------------------------------------- -------------•-----------(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 -------------- -------------------------------------- DATE--1�•� �{� <br /> REVIEWEDBY------- -------------------•_---------- - ------------------- --------------------------------------------------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED---------- -------------- -----------------------------------–------------------------ ------------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations---------------- -----------------------------_----------------------------------------------------------------------------------------------------------- <br /> ------------ -­----------­---­--- -------- ------------------------------- -------------------------------------------------------------- -------------------------------------------------------------------------------- <br /> -------------------------------------•----- ----------------------------------------------- ------------------------------------- --------------------------------------------_-------•--------------------_-------------- <br /> --------------------- -------------------------------- ------------------------------------------------------- -----------------------------------------------._----------------------- -------------------------------- <br /> ---------------------------- --- ---------------------------------- <br /> FINAL INSPECTION BY:. � -------------- Date .......---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi, California Manteca,California <br /> y Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br />