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rUKOFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT Permit No. ._ -o <br /> ------ (Complete-in Duplicate) <br /> 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. <br /> Co <br /> JOB ADDRESS ANS} CATION_ 4l, 't -l9' m'-- •----------------10 <br /> ; <br /> Owner's Name / ------- Phone <br /> ------------------------------------ <br /> Contractor's Name_ Phone <br /> --------- ----------------- -•-------------- <br /> Installation will serve: Residence [F1 Apartment House (] Commercial E] Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -1----- Number of bedrooms __,3_ Number of baths 1_.-._ Lot size �C+ <br /> Water Supply: Public system ❑ Community system ❑ Private 4C.' Depth to Water Table_ Qft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam Clay Loam Clay [:] Adobe E] Hardpan.jj 1 <br /> Previous Application Made: (If yes,date..-._-----_ ------- ) No El New Construction: Yes 5TNo ❑ FHA/VA: Yes 0 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-................Distance from foundation-----------------..Material ---.___...__..-___ <br /> ❑ No. of compartments----------------------- - Size-------------------------------Liquid depth------- ••••-- ........Capacity-•---------•----------- <br /> Disposal Field: Distance from nearest weIk5_Q ......Distance from foundation-_1174-------Distance to nearest lot '___. <br /> J Number of lines -----/____ Length of each line.____1 ---------------Width of trench.-A- °_____________________ <br /> Type of filter materia ` +_-- _'_-Depth of filter material.... _-_.'.-.------Total length--/-------------------------- <br /> Se ge <br /> ength_f.-----------_--------.---Seepage Pit: Distance to nearest welLl07R'___.----Distance from undation_Zl--_-_.Distance to nearest lot line_ <br /> - <br /> N <br /> ( ] umber of pits--- Lining material__ _ <br /> Number - - ---._..... Size: Diameter-w�.�-`6_---. -- -- � <br /> - Depth',_ " ------------------•N. <br /> Cesspool: Distance from nearest well ----------------Distance from foundation----------------- --Lining material------._----------.._ <br /> 4 ❑ Size: Diameter --------.Depth- --------------------- ------- -------------Liquid Capacity---------------- ---------- l <br /> Privy: Disfance from nearest well----------.........._____-_..__._..._.____._...Distance from nearest building---------- . <br /> ❑ Distance to nearest lot line_._-- I <br /> Remodeling and/or repairing (describe)---------- -------------•--------- ----- - ---------------------------------------------- ---------------- <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 /> 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_ - / *} <br /> DATE s---------------- 1------------- ---------------- <br /> REVIEWED BY---------------------------------- -----------_--------_---- -------------------------------------------- ----------------- DATE----- --------- - <br /> -- -- ------------------------------------ <br /> BUILDING PERMIT ISSUED-------- ---------------- ------------ ------------------------ ------------- ---------------------- DATE------------ ------------------- <br /> Alterations and/or recommendations:.- -- --------- -------- ----- ----------- <br /> ------------------ ------------------------------------- ----------- ---- ------ -------------------------- ----------------------- ----- -------------•-------•--------------- -- I <br /> ---- -- • -----._. .---I----------- ................ --- ------------------------- -------------•­:------------ ------------- --------- ---- ----",-I'll-- ------------- ' <br /> -------------------------- ---------------------------I------- -- ---------------------- --- - ---------------------- ----- -----------I-------------- --------------- ------ ! <br /> i <br /> FINAL INSPECTION BY:.. ----------------- Date-_ *_V7- -------------- ---------- -----------..------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT , <br /> 1601 E.Na:elton 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 /> F <br />