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FOR OFFICE USE: <br /> --------- ----------------------- -------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. . 67 <br /> ------------------------ - - 1-_- I (Complete-in Duplicate)------ Date Issued <br /> .-__ _-.--. This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaqui Local Health District for a permit to construc and install t w k erein described. <br /> This application is made in compliance t unty,Or ina o. 549. <br /> JOB ADDRESS AN LOCATION-...._.__ _ . . -_ ---_ . +oTr�_! <br /> °` <br /> Owner's Name. ------ -- ----- Phone---------- <br /> Address--------------------------------------------- -- ---312.... --------------- <br /> Contractor's Name r'------_----------- ----------------------------------- ------- ----------------- ----------------------------- Phone------ ............................ <br /> Installation will serve: Residence J�j Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel .] Other <br /> Number of living units: __ -_- Number of bedrooms _.3._ Number of baths__dam-.__ Lot size _ __4 4M.�_a'1 <br /> E] [I ©© <br /> Water Supply: Public system Community system Private M Depth to Water Table 7--q ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam X Clay ❑ Adobe R] Hardpan ❑ <br /> 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__1't_-_-Distan �fr �fou�ldation____1_V._4___.Ma rial ----._---------------_.-.___ 5. (v <br /> No. of compartments_.__e�-_________ __.Size ........ --. J.-_,___Liquid depth...__..... <br /> _-_-_.Capacity_ __.._._____._. <br /> Disposal Field: Distance from neare well.SG-' Distance from foundation..J..q_4......Distance to nearest lot line__S.... <br /> Number of lines__._ .._�,._____________Length of each line--106-'-._-.----__-.Width of trench._'.-��}__�_. <br /> Type of filter material- 44Z---------Depth of filter material--._._ - Total length__, --'_____________________ <br /> Seepage Pit: Distance to nearest well.`_ .__`__`---Distance from f undation--�O.-_-t..._._.Distance to nearest lot line_�'�------- <br /> IV Number of pits:.-._.------_.-.Lining mate ria l_/�(j�---- Size: Diameter----S3 -------De th_. ,�-------------------- <br /> Cesspool: Distance from nearest well ----------------Distance from foundation----------------- ..Lining material__-_----.---.----.-_._-_-._.___-__--_ <br /> El Size: Diameter- -- -------------- ----------------De th-._-__.._._-.-__-__-_--_-.------------------------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 /> 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 ruI97 and regulations of the San Joaquin Local Health District. <br /> (Signed)----- ---- -- ----- -- -- -- -- ------- ---------- --- ------ ----------- ----------- ------------------------------------------(Owner and/or Contractor) �l <br /> B -------------------------------- -------------------------------------- ---------------------------------------------------------(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 aa <br /> APPLICATION ACCEPTED BY- <br /> --------- - --- --------- DATE..-1 `4 `` <br /> REVIEWEDBY--------------------------------------------- - ------------------------- ------------------------------------------.- DATE <br /> BUILDINGPERMIT ISSUED--------- ----- ------------------------------------------------------------------------------------ DATE------------------- <br /> Alterationsand/or recommendations:------------- --- ------ --- -------------- ----- -------------------------------------------------•-------------------------------------------------------- <br /> -------------- -------------------- ---------------------------------------------_-------- ------------­_------------------------------- -----------------------------.....................---------------------------- <br /> -------------------------- ------------------------------------------_----- <br /> FINAL INSPECTION BY:. Date Date...... <br /> ------------------------ <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 />