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FOR OFFICE USE: <br /> / . 6 4 s___ APPLICATION FOR SANITATION PERMIT <br /> Permit No. . .�6. -3 <br /> ----------------------------------------------- (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 install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> s <br /> JOB ADDRESS AND LOCATION.. --- - ,P .. �i -------------------------------- --------------------------------------------- <br /> Owner's Name----.��exz&-------- `' -------------------------------------------- ------------------------------ -------- Phone------------------------------ <br /> ------ <br /> Address------- --------------------------------------------- - `i - ---............................... <br /> Contractor's Name-------------/'���-U._``_'�.�,�1..� ------------------------ ....------------------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence ['`Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _. .. Number of bedrooms A--. Number of baths .-.. Lot size _ Q -.12.1.....-------------------- <br /> v <br /> Water Supply: Public system �Commuriity system F] Private ❑ Depth to Water Table 16,10- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe®-, `Hardpan ❑ <br /> Previous Application Made: (If yes,date--------- --------- ) No ®ter New Construction: Yes ❑ No 0' FHA/VA: Yes ❑ No Zj— <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 Fi Id: Distance from nearest well----- -----,Distance from foundation-,?O?..f_.._.Distance to nearest loo line..�a_�.._ <br /> Number of lines....__.... Length of each line-_%7_47 (`. ....Width of trenchs s.-_ ..... ............ <br /> Type of filter materia � Depth of filter material__.r� _ ._Total length_..?e------------------------------- <br /> ---------- <br /> elf <br /> ----------------_-._... <br /> Seepage Pit: Distance to nearest well Distance from fo ndation_. _�._...Di t nce to nearest lot linp-4—! <br /> Number of pits---.- . ..........Lining mOerial <br /> �'� _-Size: Diameter..��-_.-_....__Depth-.X' ..._...._.._.-------- <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 /> ..--- 1 � --- <br /> -------------------------------•------•------ •------11-------------- ----------------------------------------------------------------------------------------------------------•-----•------------------ ------ <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) -- -"° "l � "r ( r Contractor) <br /> By:-----------------------------------------` � f = '--------------- - 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 -e-- - DATE /..47----------------- <br /> REVIEWEDBY----- -------------------- ------ ---------- ------ DATE----------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED-------------------------------------------- -- ------------------ DATE------------------------------------ ------------------------ <br /> Iterationsand/or recommendations---------------------------- ------------------------------------------------------------------------------------•-------- -------------------------- <br /> ----------6avdve:n-------------90----------------------------------------------------------------------------------------------------------•------------------------------------••---------------------- <br /> ------I------------------------------- <br /> -------------•---------------------------- ----------------------------- ----------------------- ------ ---------- -----------------•----------•------------ -------•----•----------------_-- <br /> ----------- -------- --------------------­------- ---------- -------------- ----------------------------------------------- •----------•--------- --•-••--•---------------. ------ <br /> --D-- -- - ---------- -------- ---------- ------------------------------------------------------------------ •------ <br /> FINAL INSPECTION BY:.---- - sl---------------- --- - Date.--- ®z/- ?---- ----- <br /> S`AN 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.0 O. <br />