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FOR OFFICE USE: <br /> --------------------------------------------------------- <br /> APPLICATION FOR` / <br /> _____________. _________ <br /> ---- <br /> - _ _ SANITATION PERMIT Permit No. _. ._. _... <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 AND LOCATI N------t, 1-P6.-- -----------_------ -- ---- <br /> Owner's Name kA44*Ak---------------------------------------------------------- --------- ­---------------------------------------- Phone------------------------------------ <br /> ------------ <br /> Address- ------------ - ---------------------------------------------------------------------------------------------- ------------------------------------------- <br /> Contractor's Name.---- `S ---------------------------------------- --------------. Phone.-----------••------••------------ <br /> Installation will serve: Residence U��Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: .____. Number of bedrooms .I, Number of baths__1_.._ 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, 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 nk: ; Distance from nearest well.................Distance from foundation--------------.___Material ....----_.__.--__.___.___--__-__---..--_.____-_. <br /> No. of compartments--------------------_----Size-------------------- -----------Liquid depth--------- ------- ---- -- Capacity--------- ------------ <br /> Disie d Distance from nearest well- -- --------Distance from foundation__A.- ---------Distance to nearest lot line--- .___..... <br /> posae Number of lines-------/------------------------Length of each line_ ._.-_.___._.Width of trench_--1'-----/__________________ <br /> Type of filter material-__�) -'4-L-4-------Depth of filter material-/d'h-------------Total length__.td'./-_-... --_-__________--- <br /> Seepage Pit: Distance to nearest well-.... ----------------Distance from foundation--------------------Distance to nearest lot line----------------- <br /> ElNumber of pits-----------------.--Lining material-------------.-------- Size: Diameter--------------- -------Depth_.------__.---•--_-._..-.-___. <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 /> ❑ Distance to nearest lot line -------------------------- ------- --------•-•----------------------------------•---------------- ----------- ---------------------------- <br /> Remodelingand/or repairing (describe):---------------------------------------------------------------------------------------------------------------------------------------------------_--- <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 law and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)--------------- ` ------ <br /> --- ------------------------------------------------------------•--------------------------------- ---(Owner and/or Contractor) <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-------- -----`----------- C'2P------------- ------------------- --- 1--- - ------------ DATE---I_ -`II -------------------------------- <br /> REVIEWEDBY----- ------------------------------------- -------------------- ------ DATE-------- --------------------------------------------------- <br /> BUILDING PERMIT ISSUED---------- --------- ------------ --- ---- ---------------------------------I--------- DATE---- - <br /> Alterations and/or recommendations:_-__-V--:--:------► -- 4.- ----- - -____- 1 ­.6-- <br /> -- �- <br /> --------- <br /> ------------------------------------------ ------------------------------------------------- ------------------------------------------ -------------------- ----- --------------------------------- <br /> - --- <br /> FINAL INSPECTION BY:.----U.= - Date-- ( c� -S, <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton 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 />