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FOR OFFICE USE, <br /> ______________ _ APPLICATION FOR SANITATION PERMIT Permit No. w� :._3.v'``— <br /> -------------------------- --1/--i --- --------- (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 irr all the work herein describe <br /> This application is made in compliance with County Ordinance No. 549 <br /> et� <br /> r l <br /> JOB ADDRESS AND L CATION_Z/ _-_= ........a,_44 ., _ -_._-_. <br /> Owner's Name --------= ------------ - ---- Phone------------------------------------ <br /> Address......... <br /> ---------------•------••-----••----Address_..--.... , <br /> Contractor's Name ^� `" Phone_G` '�/•. ------- ------------- <br /> Installation will serve: Residence RApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _/_ Number of bedrooms _ __ Number of baths Lot size <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water TableAe_ 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 New Construction: Yes ❑ No V®' FHA/VA: Yes ❑ No Z-- <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 /> /5 11" No. of compartments_-------- ----------...Size--------- ---------- -----------Liquid depth-------- --- --- ------- Capacity-----------••---------- <br /> Dis osal Fiel Distance from nearest well.................Distance from foundation--------------------Distance to nearest lot line----------------- <br /> 1 i1 Number of lines-------_____________...---------Length of each line__ -------.------ ------------Width of trench_.-------------------.------....... GI <br /> Type of filter material-_-___-_-____--_-.--__Depth of filter material---------------- ---Total length------------------------------------------ <br /> See e Pit: Distance to nearest well__Z� ..Distance fr m fo�ndation__���......Pistanc5e tonearest lot Pline-. %'_`_ <br /> cNumber of pits--/------ ------Lining material- /T Size: Diameter�k.Fk#le_Depth--�---------------•----------- <br /> Cesspool: Distance from nearest well ----------------Distance from foundation----------------- -.Lining material-----.._.-__-_----_-___.-________.__ <br /> ❑ Size: Diameter- - ------- - -----_ ----Di� th--.............�------------------------------------Liquid-Capacity------------- - ---------gals. <br /> Privy: Distance from nearest well x' ----------------- Distance from nearest building------------------------------------------ <br /> 0 <br /> _-____ ._. ____ _-____...__._._. <br /> Distance to nearest lot Ii e ---------- -- ------- <br /> - - --------------------- - - ---------- -------------- -- --- ------ --------- <br /> Remodelin9 and/or repairing (describe). -•- <br /> f�r---------••------------•--- - - ------------------••------••------------•--- <br /> ------------------------------------------------------------------------------------------------r--------- ------------------------------------•-------------------------------- --------------- --------------- <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)................... ( '' % ' --------­----- - -- -------_--------------------------------------- ter'Contractor) <br /> -- ---< ----- --Title <br /> By:------------------------------ --- � - ( ) t �1 -- -- ------------- <br /> (Plot plan, showing size of lot, location of syst in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY__. ------ - ----4 -- :___________________ ----------------------- ------------------.- DATE-------- <br /> REVIEWEDBY------------------ ---------------- --------- -_---------- ----------------------------___------------------------------- DATE----------------------- <br /> BUILDING PERMIT ISSUED--------------_------------------------------------------•-' -------------------- ------------- DATE--------- --------------------_-- --_--------- <br /> Alterations and/or recommendations:----------------- ------- -------------- -----------------------------------------------------------------------------------------------------.-_ _ <br /> ---------------------- ----------------- ---------- ------ ------------------------------------------------------ --------------- --------------------------------------.-------- ---------------- ---------------- <br /> - �{ --- --------------=1---------- --- --------------------------- ---------- -- --------------------------- <br /> ------------- ------------ <br /> FINAL INSPEC11814 BY--).-- -----�----- -- ---- ------- Date----................ Z 3.- 6 -------------------- <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 />