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FOR OFFICE USE: <br /> zf-DQ� <br /> APPLICATION FOR SANITATION PERMIT Permit No. ...o�,, <br /> .......... <br /> -------------- -------------------------- ----------- -- (Complete in Duplicate) , <br /> 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 with County Ordinance No. 549. <br /> JOB ADDRESS AND4LCATIOU._x044,?.._ __3 ____ .......�.. .__ <br /> Owner's Name. ------------•--••--•----------•-------------- ------------------------------------------ Phone------------------------------------ <br /> Address i .... . . <br /> s------ ---- --• ---------------------------------------------------- <br /> Contractor s Name-- �: "1'f N ---- Phone.. - l/ <br /> Installation will serve: Residenc Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -------- Number'of bedrooms -------- Number of baths _-X'_ Lot size ._L Jr� _t lZ____________ __________-_. <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 ❑ 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 PECIFICATIONS: -_-- - <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet. <br /> Septic Tank: Distance from nearest well__ Me-Distance from foundation___3_..k�-_}Mater7nl_-_-.--_-_--_-________________________-.__-. <br /> [�� No. of compartments--.-__ -______.._____ Size___ �.d4�.__-Liquid de th____-:__________________Capacity------------------_--- <br /> Disposal Field: Distance from nearest well. .ts Distance from foundation.___3. - -_-__.Distance to nearest lot line., . <br /> [ � of lines.-_�---- _. __-_ ___Length of each line___l.? _ Width of trench_ 1���� <br /> Type of filter material_�'N"-_/Q�Depth of filter material_ $_ _-.- _.__ Total length__-_)._;w-_ <br /> ------ <br /> Number <br /> Seepage Pit: Distance to nearest well______-___-_.-_-___Distance from foundation--------------------Distance to nearest lot line_-__.-_-_-_-_._- <br /> ❑ Number of pits--.--____-.__.------Lining materia l__..____-__.__..._.Size: Diameter_______________________Depth----._.-.___-.__.--__-_.-.___ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation__'------------------Lining material-------------,------.__---.--_-_-- <br /> ❑ Size: Diameter--------------------------------------Depth---------------------•------------------------------Liquid Capacity_-------------------------g Is. <br /> Privy: Distance from nearest well __...-------------------------------------------Distance from necirest b'tilding-___________-_______________ <br /> ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------•--=--------------- <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 /> ---- ` --- --------------- --------- - -- -------- - -- ------ <br /> - -(Title)-----------------------------., --- --------- <br /> BY: <br /> (Plot plan, showing size of lot, location of s m in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEP TMENT USE ONLY } <br /> "APPLICATION ACCEPTED BYrR -fi-------------------------------- - -------------------------- DfTE <br /> --------------------------- <br /> REVIEWED <br /> --- ------- - --REVIEWED BY ------- --------- ----- ------= --- ----- ------ DATE---------- --------- --------------------- �. <br /> BUILDING PERMIT ISSUED --- ------------ -----• - -- DATE-------------------- ------------------------------------- <br /> Alterations <br /> - -- - ----- ----------- --Alterations and/or recommendations:- - -------------------------------- ------------•--------------------- ------------------------------------------------------------ ----------------- <br /> ----------------- <br /> -------------- <br /> ---------•------- ---------------------------------------------------- - <br /> ------------ ------------------------------- ------- ------- ---------- - ---- ------------------- ------------ -------------------------------------------•----------------------•--------------------- <br /> -- ----- -- --- --------- -- - ------------------------------------------------------ - •- ----- --- <br /> FINAL INSPEC- PI-B -- ! Dete=-------- L '.��•�� '" <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.C O. <br />