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FOR OFFICE USE: y <br /> z= ------------------ Q- -�- <br /> ---------------------------------------.-------- -------- APPLICATION FOR SANITATION PERMIT Permit No. . e'_ .. <br /> ------ - (Complete in Duplicate) <br /> Date Issued <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 /> JOB ADDRESS AND LOCATION------� .6_ <br /> Owner's Name ! ��__-...��"4-�'� ---------- --------------------------.- Phone--•--------------------------------- <br /> ------------------------------------------------------------------------ <br /> Address---_`f�.U_-�3..-- ---- <br /> 7s <br /> Contractor's Name ------------------------------------------------------------------------------------------------------- Phone................................... <br /> will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ----I--- Number of bedrooms _2-_ Number of baths __t--- Lot size _J�X4_2_-3 0--------------------------------- <br /> Water <br /> __ __ _Water Supply: Public system ®' Community system ❑ Private ❑ Depth to Water Table 0 ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Eq--Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------- ----) No 91'_ New Construction.: Yes ❑ No [ FHA/VA: Yes ❑ No n— <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 /> .._..________.._________...__________.__.___.___. <br /> ❑ No. of compartments_-----------------------Size----------------------------....Liquid depth--------------------------Capacity----------------------- <br /> Disposal Fi Id: Distance from nearest well-----------------Distance from foundation_A--------------Distance to nearest lot line_ /..... <br /> E16Number of lines-----L--------------_-------------Length of each line_aeo--------------------Width of trench._ -"___.__---_____--- <br /> Type of filter materia L_--lZe7r-.-----_Depth of filter materiaL_._L,Y_"-_____.Total length-------- ' <br /> Seepage Pit: Distance to nearest well----- ------------Distance from foundation__lsQ..._.___....Distance to nearest lot line-_--- ____�_.. <br /> ®� Number of pits.__/____._ __Lining material I—c-r_/(___.Size: Diameter__3.3__'__..__-_Depth-.__-_ZJ_-'___----____--• ."D <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 <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, StatZI ,snand rules and regulations of the San Joaquin Local Health District. <br /> (Signed)-------------- ----------------------- ---------------------------------- ------------------------------------------------------------------------- Owner and/or Contractor) <br /> ( / actor) <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---------------- - ------------------------------------------------------------- DATE---------/�IZZ 15-------------------- <br /> REVIEWEDBY------------------------------------------ ----------- ----------------------------- ---------------- ------------------ DATE---------------------------------------------- <br /> BUILDING PERMIT ISSUED--------------------- --------- --. DATE---------------- - <br /> Alterations and/or recommendations:. ���12- �''`�'`' ¢`=<<�--------------------- <br /> ------------------------ <br /> ----------------------------------- --------•------------------------ ---------------------- ----------------------------------------------------------------•------------------------------------------------------- <br /> ----------------- ----------- -----------------------------------I---­-------------------------­ ------------------------------------------------------------------------------- --------------------- <br /> ------------------ ------------------------------------------------------------------------------------------------- ------------------------------ ------------------- ----------------------------- --------- <br /> FINAL INSPECTION BY:---.- - --------------------------------- Date------ // = '-" J------------ -------------------------- ------ <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 /> F.P.C o. <br />