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FOR OFFICE USE: <br />-------------- ---------------------------------------- - - <br />------------------------------------------------------ <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in in Duplicate) <br />- - - Date Issued - _IA4l---4_ <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 /> ------------------------- <br /> JOB ADDRESS AND LOCATI '7?aG - Yf.Z � P__ Q . <br /> ------------------------------------------- . <br /> Phone_.... <br /> Owner s Name---- <br /> - --- ---------- �- --------------------- <br /> -._... ---------------- - ------------------ <br /> Address---------- ���- - <br /> ----------- <br /> sr _...cz--------------------------- <br /> Phone----------------------------------- <br /> -------- <br /> Name ------- `--•�'6-,�y�------6-------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ----/-- Number of bedroomsNumber of baths -1----- Lot size -__ ------------------ <br /> Water Supply: Public system ❑ Community system ❑ Private 0 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 /> -.-----) No ❑ New Construction: Yes No E] FHA/VA: Yes E] No El <br /> Previous Application Made: (If yes,date-------------- ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f <br /> Septic Tank: Distance from nearest well----SO!----DistaP from_foundation__._ M_ aterial_____ _ _ <br /> _---------------- <br /> No. <br /> - ------- <br /> No. of compartment __- SiGG XSLi uid de th__ ' Ca acitYerQ9 <br /> ze-- -- <br /> Disposal Field: Distance from nearest well----�5`p.-°._Distance from foundation----/a----------Distance to nearest lot line�_�..__.__.. <br /> ry Number of lines----------/----------------------Length of each line---- -__---_------------Width oftrench.� ---___,-_-_-__.___._-___--__� <br /> Type of filter materiaL__ 's1 !.___-_.--_Depth of filter material___._ . Total length__________________________________________ <br /> ------------ <br /> Seepage Pit: Distance to nearest well-------I_dP__-----Distance from foundation-----/R.._____.Distance to nearest lot line___•..____-._ <br /> Number of pits / 3 -Depth--- z S� <br /> _Lining materia <br /> Cesspool: <br /> Diameter_____.__._ - <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-----------.--------Lining material------------------------------------- <br /> F1Size: Diameter-------------------------------------Depth---------------------------------------------------Liquid Capacity----------------------------g �. <br /> Privy: Distance from nearest well_----------------------------------------------Distance from nearest building__-__--__..-____-___________---__-___----. <br /> ❑ Distance to nearest lot line--- ----------------------------------------------------------------- --------- G <br /> Remodeling and/or repairing (described4 --- <br /> ----------------------------------•------------------------- <br /> d -+- <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, r les and regulatio f the San Joaquin Local Health District. <br /> (Signed)_ __ ef-mor Contractor) <br /> ------•----------- ----jo- ------ ----- ----- <br /> ---- ------------------------------------------ <br /> ------------- <br /> °� Title - <br /> BY:---------------- ----------------- ----------------- ----------- ---------------------------( )------------------------- <br /> ------------------------------ - <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 /> . f <br /> APPLICATION ACCEPTED BY--.-- /1 �-------------------------- <br /> ---- - ---------------------------------- ---------------------------------------- DATE-----�-� --._. <br /> ------- <br /> REVIEWEDBY---------------------------------------------- -------------------------------------------- DATE------------------------------------------------------------ <br /> BUILDING PERMIT ISSUED------------------------------------------------------ ----- DATE---------------- --------- -----• <br /> Alterations and/or recommendations:__.------------------------------------------- --------•--------------•-----------' <br /> -------•----------•-------------- -------------------------------------------------------------------•------------------------------ --------------- ------------------ <br /> ----------- - - - <br /> ---•- •-------------------- -------------------- ---- -------------------------------------------- <br /> ------------------------------------------------------------•--•- -------- ----------------------------------------- <br /> . <br /> FINAL INSPECTION BY:---- --------------------- Date_���'Z'`-'-----�----- - <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 />