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FOR OFFICE USE: <br /> ------------------------------ -------------------------- y <br /> __--- APPLICATION FOR SANITATION PERMIT Permit No. ........................ <br /> ------------------------------------ -------------------- {Complete in.Duplicate) '3 - 18 ` { I <br /> jThis Permit Expires 1 Year'from Date Issued <br /> Date Issued -------------. ------- <br /> Application is hereby madeTto+he San Joaquin Local Heal+h District for a permit to construct and install the'work herein described. <br /> This application is made incompliance with County Ordinance No. 549. <br /> JOB ADDRESS-AND LOCATI N � - ; ..�' file ✓4_.`i!x~. f; <br /> -s" I <br /> Owner's Name *h ` � 4 <br /> = '� ------ ione, <br /> e---------------•----•--------------- <br /> Address----------- I __ __. ... . � ------- ---------••-•-----•-•--------------•- ! <br /> ------------ <br /> .- h a ' <br /> Contractor's Name------=--------- ----•-------•------ - --- <br /> - --- -------- ------------•-----------------....._----•--- -----------------------------•--- <br /> Installation will serve: Residence ff Apartm6nt House'[] 'Co mmercial'❑ Trailer Court [3 Motel ❑ Other El4 <br /> j <br /> Number of living units:�_�.___ Number of bedrooms I---- Number of baths Lot size ------ ___________________________ I <br /> Water Supply: Public system ❑ Com unity system'❑ Private �epth to Water Table `g.' <br /> Character of soil to a depth of-3 feet: Sand ❑ Gravel ❑ Sandy Loam [L�Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If,yes,dote-- ----- -----------) 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 /> No. of compartments Sim ------------Liquid d.--- Material---------------------------------------------acit ._.. <br /> Septic Tank- Distance from nearest wel�___�_;-;-•_''_____Distance from foundation_______,_epth ____________ _________Capacity__.________�i_:,__. <br /> Disposal' Field: Distance from nearest welI1__V nce from foundati ._ <br /> �? istance to nearest lot me__- _' ltir�� <br /> ® Number of lines______ _____ '• Length of each line______�___�-- Width of trench______ 1.0 <br /> ' - <br /> Type of filter material__ E?r____. th of filter material------I_,�____.....Total length----------5_d_____________________ <br /> t Y <br /> Seepage Pit: Distance to nearest well-----------------------.Distance from foundation....................Distance to nearest lot line__.___________-- <br /> ❑ Number of pits---------- r----:!--Dining material-------------- --------Size: Diameter----------------- De,p h _- == =•= <br />­i�­�Cesspoal w� -Dista rice from nearest well --- Distance from foundation-------------------_Lining material-__.____.__--_____--___. <br /> ❑ Size: Diameter--------- -------- ---•---Depth-------- ------------------------=------------------Liquid Capacity----- -•--•---•------------gal - <br /> Privy: Distance from nearest well:-----------------------------------------------Distance from nearest building----------------------------_-___.------1Z <br /> ❑' Distance to nearest lof line --------- --------------------•-- --------------------`---- _------------------------------------------•---------------- <br /> ,, <br /> Remodeling and/or repairing (des be): 4 ---------- --------------------r. <br /> � s. <br /> - -- ----- -- <br /> �f - --•---- ------- --- ---------------------------•••---•-------------------------- <br /> ----------------- -----•-••------------------ .._ <br /> Q ' <br /> w . t�. { <br /> ! hereby Ger ' y that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, 5ta aw and,r les a regulations of the San Joaquin Local Health District. <br /> {Signed)-,---- ----------'------------------ --- - � - -----•-------------------- ----------------_:--- (Owner and/or Contractor) <br /> B , ,. <br /> ----------------------------------- ---------•-•------------------------------------------------------- {Title) - - <br /> (Plot plan, showing size of lot, ocation of system in relation to-velli, buildings, etc., can be placed on reverse side). - , <br /> I O P R M J USE <br /> Ly- <br /> - 4 <br /> APPLICATION ACCEPTED BY----- . _ ------- ----- ATE----- �------------- <br /> REVIEWEDBY--------------'---------------------------=-- --------- DATE---------------------------------------------------------- <br /> BUILDING PERMIT ISSUED------------------------------------ -------- ---------------------------------• DATE--=-------------- ---------- <br /> -------------------------------- <br /> Alterationsand/or recommendations:----#-------- - - ---------------------------------------------------......­ --------------••-•-----•--•--------------------------------•------•-----------•- <br /> F <br /> ---------------------------- <br /> 7------------ --------- ----------------------------------------------- -------- -----------------------------------------------•-----------------------•-----•---------------------------._---•-----. ------- <br /> --- --------------------------------------------- <br /> FINAL INSPECTION BY:------- Date ------------------------ --------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 306 West: ok Street - 124 Sycamore-51re.at 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> E9-9 REVi9 ED 8.69 f.P.0 O.3M 6.60 '� <br /> z <br />