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FOR OFFICE USE: <br /> -------------t ------------- i------ <br /> APPLICATION FOR SANITATION PERMIT PermitL <br /> No. <br /> --------------------------------------------- (Complete in Duplicate) 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 withCou ty Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION--/O';7' <br /> -------------------------------------- ------------_­­------------------------------------------------------------------------------------------ <br /> Owner's ------------------------------------------------------------------------------------------------------ <br /> _4Phone------------------------------------ <br /> Address--_------------------.... t.4.... -1--------- ------------- <br /> --- <br /> -----------------------------------------------------------------------------------------------------------------------------------------........................................................... <br /> Contractor's Name S7 ------I............ <br /> Phone................................... <br /> Installation will serve: Residence [Apartment House E] Commercial F] Trailer Court ❑ Motel ❑ Other E] <br /> Number of living units: J--- Number of bedrooms wl-- -. Number of baths J.... Lot size ------�*------- ------------------------------------ <br /> Water Supply: Public system A�Community system E3 Private E] Depth to Water Table Ok_6 ft. <br /> Character of soil to a depth of 3 feet: Sand F] Gravel E] Sandy Loam E] Clay Loam Ej Clay ❑ Adobe e"Hardpan ID <br /> Previous Application Made: (If yes,date--__-_-_-_--.-_-) No New Construction: Yes El No pr"'FHA/VA: Yes E] No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Sept' ank: Distance from nearest well_________________Distance from foundation--------------------Material------------------------------------------------- <br /> No. of compartments----- -------------- -----Size--------------------------- ---Liquid depth-------------------------Capacity-.-------------------- <br /> Dis al Fiel Distance from nearest well_-_-_-_._:-__-._Distance from foundation....................Distance to nearest lot line-__-____-_------_ <br /> Number <br /> ine----------------- <br /> Number of lines_-_______-.-__.-____.._-._-_---_Length of each line------------------------------Width of trench____________________________________ <br /> Type <br /> rench----------------------------------- <br /> Type of filter material----- -------------------Depth of fi I e I---.____-_-__-._.__.-Total Total length------------------------------------------ <br /> :e ff6 -imoo . <br /> Seepage Distance to nearest well---—----:.-------Dista om unda on4l!�...........Distance to nearest Iotjjne--------------- <br /> f <br /> Number of pits-------/-------------Lin ng ate . . ... 3 <br /> ize: Diameter....... -------Depth---­7!� ~_............. <br /> 'foundation------------------ Lining material_._____.._____.____..___....______._.. <br /> Cesspool: Distance from nearest well-----------------DisfaCn ou nd afi` <br /> 1:1 Size: Diameter----- --------------- ----------------Depth------------------------------- ------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_----__----__--_--_---________---_.------. <br /> ❑ <br /> uilding------------------------------------------ <br /> F] Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------­----------- <br /> Remodelingand/or repairing (describe):--------------------- ----------------------------------------------------------------------------------------------------------------------------------- <br /> -----------------------------------------------------I------------------------------------------------------------------------------------------------------------------------------------------------------------------ <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, State laws, and and regul ions the San Joaquin Local Health District. <br /> (Signed)------_---------- .... .... ...................... ................. .........I----------------------------------------------------------------(Owner and/or Contractor) <br /> By:-------...............................................................-----------------------------------------------------------(rifle)------------------------------------------------- ------------ <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 /> APPLICATIONACCEPTED BY--..--------(------------------------------------------------------------------------------------- DATE------/....... -----­---------------------- <br /> REVIEWEDBY-------------------------------------------- -------------------------------------------------------------------------------- DATE----------------------------------------------------------- <br /> BUILDING PERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- <br /> Alterations and/or rec9mmendationp:--------------­--- -------------- -----------------------------I---------F.............................................­.................................... <br /> I----------------111� <br /> - -- - ----a- -------------- ------------------- -- <br /> ------------ ------------------------------------------------------------------------ <br /> --- ---- - -- <br /> -----------------------------------------------------_---------------I------------------------------------------------------------------------------------------------------------------ ---------------------------------- <br /> --------------------------------------------------------------- ------------ ------------------------------------------------------------------------------------------------------------- ------- -------------------------- <br /> ---------------------------------------­­--------- ----------------- --------- ------------- ------------------------ ----------------------------------------- ---------­­---------------------- <br /> FINAL INSPECTION BY:--------cef�.----------------------------------------I--- Date...... <br /> ----------- ------ ------------------------------------- <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.00. <br />