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FOR OFFII-E USE: <br /> ---- ------ -- -- <br /> APPLICATION FOR SANITATION PERMIT Permit No. Z.h... / <br /> t <br /> (Complete in Duplicate) Date Issued <br /> . ............ 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 AND LOCATION------- 7 �`' N 1`j ---------------- ---------­--------------------- <br /> --- <br /> x ----- _� J ------- -- <br /> Owner's Name. Ph one. ._ - ." <br /> Address- 1�---7 j i1�✓.). -/ ---------------- ---------------------------------------------- ------------------------------------------- <br /> Contractor's Name....... <br /> = � -�---------------- ----------- ---- ----- ��-.--_= - y <br /> l 'C <br /> Phone.-- .- <br /> Installation will serve: Residence ;R( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -J.-- Number of bedrooms _JJ- Number of baths -1 .. Lot size -.-. ------------- <br /> Water Supply: Public system LN Community system ❑ Private ❑ Depth to Wafer Table -....--. if. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay A Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date......... - 1. No a New Construction: Yes ❑ No ® FHA/VA: Yes ❑ No �4 <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 /> ❑ No. of compartmenls----- -- ---- - - Size------------- ---------------Liquid depth------------------------- Capacity----- ---- ---- - - --- <br /> Disposal Field: Distance from nearest well _ _ Distance from foundafion--------------------Distance to nearest lot line-.--_-,--_------. J <br /> ❑ Number of lines- --------------------------------Length of each line_----------------------------- of french_ --- J <br /> Type or filter material-------------------------Depth of filter material__-.--.- -- - - --- -Total length-.-.--.--.-.----______.______________--__ <br /> Seepage Pif: Distance to nearest weU--------'- --------Distance fr m foundation__-_?4+--'.-__Distance to nearest lof line..---'- '_....- <br /> Number of pits----- --------- --Lining material.. Cl<' Size: Diameter._X _, ._. Dep+h-__1Cy_°-------.-_--- <br /> Cesspool: Distance from nearest well-----------_----Distance from foundation. ----------------Lining material------------- <br /> ❑ Size: Diameter------------------ -------------------Depth----- --------- ....... Liquid Capacity- ---------.'....._..-------gals. <br /> 9 <br /> Privy: Distance from nearest well----------------------------_--------------------Distance from nearest building................................-......... <br /> ❑ Distance to nearest lot line - --------------------------------------- ------------------------------------- <br /> Remodeling and/or repairing (describe):_.. ...... _z-" _____.__ 2 _. <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 lawsrules and regulations of the San Joaquin Local Health District. <br /> Si ned __lQwrTr nd or Contractor <br /> B _ ,.— ------- -1:tel-.T- -.: .-�C----- - ----. -------------------------- .. -_{Title <br /> (Plot plan, showing size of lot, cation a ystem in relation to wells, buildings, etc., canbe placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_ —- --- - ------ -- - ------ ---- ------- DATE ! - l --------- <br /> REVIEWED BY- -. - ---- ------------- ------ - DATE----- -- - -- -------------- <br /> BUILDINGPERMIT ISSUED----------------------------------------------- --------------•--------------------------------------- DATE--------------------.--------- ------ ---------------- ---- <br /> Alterations and/or recommendations:..-. ----- -- ----------------------------------------- .................... -- --------- •---------------.-.-..-.-. <br /> - ---------- --- ----..----- --- ---------------------------- ------------------------ .------- .-..... -- - ------ ------------ ---- ------------------------. <br /> Dated <br /> FINAL INSPECTION BY:---� G -.!_, .: - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haielton Ave- 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> F.p.CO. <br />