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FOR OFFICE USE: <br />---------- -----------_---- ------------ ------ ...... <br /> APPLICATION FOR!SANITATION PERMIT Permit No. <br /> ______._.__ _- <br /> ._ __ (Complete-in Duplicate) <br /> f�/�� t - This Permit Expires 1 Year From Date Issued 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. 0_2 91 <br /> JOB ADDRESS AND L CATIONS-�! • ..c>t '� . '40( <br /> Owner's Name-------- ..-• •------- --- --)V&%.�:d-Phone-----•-----•--- <br /> ��77 � �_ <br /> Address--------ff '" /--�-----------,�' ��, -_- ��` ---•-•--- �C�---- ----------------------------------------- <br /> Contractor's Name L..._-a--------- --s- - -•-------•- = - ------------- Phone <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _/___ Number of bedrooms _%7.. Number of baths__/__ Lot size ---�_ ------ ----------------- <br /> Water Supply: Public system ❑ Community system ❑ Private (Depth to Water Table/W__�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,date---------- -------- ) No 09' 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.) te <br /> Septic Tank: Distance from nearest well-_. __ ..._Distance from foundation_-.I�1.'__._____.Material_.S..�c--. ' <br /> No. of compartments-----a---------------Size__,,V_xG_xj5r:_..Liquid depth_._+�f___- ------- Capacity./JQO_� <br /> f <br /> _ O_�_---.Distance to nearest lot line....Disposal Field: Distance from nearest well__4-�___�_ Distance from foundation.. <br /> Number of lines_.._____-. <br /> [�" c�__ ..._ Length of each line__ :�G.�C'._"�_...Width of trench..---pT���_____________ <br /> Type of filter material__./ <br /> ... of filter material--- �__.. ___Total length__.. __ ___________________ <br /> Seepage Pit: Distance to nearest well_le-a----._-__Distance fr m f undation__/0--__----___.Distance to nearest lot line._-_----_.- <br /> Number of pits_ aq_._ .. _Lining material._. __ --__ Size: Diameter__,Y,?_.. ......Dept h.....024-----_.____-_-- <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 /> Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------------------- --------------- ........ { <br /> ---------------------------------------------------------- ---•-------•-------- ------•-------------------------------------•---------------•---------- ------ ----------- ------•-------•-------•--•----------------- ------ <br /> -----------1----------------------I--------------------------------------------------------------------------------------------------------------------- <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 and regulations of the San Joaquin Local Health District. <br /> (Signed) ------------ ------------_--------------------- --(Owner and/or Contractor) <br /> - -- - ----- ---- -- -- - - <br /> BY:------------- � - ------(Title)------ ----- ------ <br /> (Plot plan, showing size of lot, Ioc ion of Sys tion to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - ----------------- -------------------------------------- DATE-l©-^ --------------------------- <br /> REVIEWEDBY------------------ -------- ----------------- -_---------------- ----------------------- ------------------------- ---------- DATE------ -------- -------------------------------------------- <br /> BUILDING PERMIT ISSUED---------- ---------------------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:------------ -- ---------------------------------------------------------------------I------------------1 ------------_------------------------- <br /> ------------- ------------------------------------------------------------- ------------------------------------------------------------ ----- ---------...--------------------------------------------------------------- <br /> ------------------------------------------------------- ---------------------------------- -------------------------- -------------------------------- ------------------- --------- --------------------------------- <br /> ----------------I------------ --------- <br /> ---------------------------------------------------------------------- --------- ----• ---------------- - --------------- ---------------------------------------- ---------­-- -------------------------- --------- --- ---•------------------------ <br /> - ----------------------- ----------------- ------------------------------------------------------------------------------------- ----------------- -------------- ------ <br /> FINAL INSPECTION BY: . - ---------------------------- ------------------------------ --------- <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 />