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FOR OFFICE USE: <br /> ------------------------------------------------------ <br /> APPLICATION FOR SANITATION PERMIT Permit No. .�:._ :.. !�__ <br /> r (Complete-in Duplicate) <br /> ---- ----. -- This Permit Expires 1 Year From Date Issued <br /> 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 A OCATION._ ----- --------- ----- --------------_ <br /> f --- , <br /> ?--------------- ----------------------- <br /> Owner's Name- -- --- - -------- -- �-_--e nc_--- ------------ Phone------------------------------------ <br /> Address.... <br /> -------------------------------•---Address <br /> Contractor's Name----- ----------- ---------- Phone------ --------------------- <br /> Installation will serve: Residence ❑ Apartment House Commercial Trailer Court <br /> ❑ ❑ Motel ❑ Other <br /> Number of living units: --/-- Number of bedrooms 'Number of baths Lot size ___/e7c' ___,*'1,0C;______ <br /> Water Supply: Public system [/Community system ❑ Private ❑ Depth to Water Table -__.__ _ ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam [n"'Clay Loam ❑ Clay ❑ Adobe ❑ 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 T k: Distance from nearest well_,j ? .Distance from foundation___./GZ.____- Material <br /> No. of com artments_._- ,. �-��'_��.�-Liquid __ <br /> depth_, '.____ _ �,G1Q__�� <br /> __--_ Capacity � <br /> Disposal ield: Distance from nearest well«.s•_.1,Cf"✓_'f- Distance from foundation._,f-4_.r___._.Distance to nearest lot line---1/3___--. <br /> Number of lines_---------..Q-------_ <br /> .__._Length of each line__ __� _ _ <br /> E'.'__._. __ _.Width of trench---5;;�.�-_------_.-_--_-_--- <br /> Type of filter material__._ _>Z_�...__Depth of filter material__..%f_ Total length D <br /> /� ----------------------- <br /> Seepage Pit: Distance to nearest well_--------------------Distance from foundation_____-_______.__-.Distance to nearest lot line.-----____.__.._ <br /> ❑ Number of pits.------------------Lining material------------------- - Size: Diameter----------------------Depth--------_------------------- <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 /> --------------------------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):--- ------_----- <br /> -- ----------------- --------------------------------------- ------------------------------------------------- ------ --------------------------------- ------ -- <br /> --- ---------------------- <br /> ereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, II to laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)--X 6------------ -------- _­- ---- -- ------ " e1 and/or Contractor) <br /> ---- .. (Title)--(Pl ' <br /> of plan, owing size of lot, location of system dIelafion to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY__._ : - a <br /> • � 4` =''� - ------ <br /> --- - - ----- ---- --- -------------- <br /> -- - ----- DATE_ _�`` --- - ----- <br /> VIEWEDBY - ------------ -------- ---------------- --- --- - --- DATEE- <br /> UILDINGPERMIT ISSUED-------- -- --------------------------------------------------------------------------------------- - <br /> ------------------------ <br /> A aerations and/or recommendations:------ ---_______ <br /> ------------------------- ----------------------- ------ ------------------- -------•-- <br /> -- ----------- ---- -----•---------- ----- ---------------------------- ----------- ------ <br /> FINAL INSPECTION BY:-_.r� ` � <br /> f. - Date . ., :-- �' l <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street <br /> 20.5 West 9th Street <br /> Stockton,California Lodi California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />