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FOR OFFICE USE: /f <br /> 1a- �-- ------------- -4m - �- -�- <br /> APPLICATION FOR SANITATION PERMIT Permit No. -------------------—_-- - <br /> --------------------------------- - ---------- <br /> -,- 1, (Complete-in Duplicate) 4 -- <br /> _._ ----.__..___ --- ---- This Permit Expires 1Year 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 /> JOB ADDRESS AND LOCATION----- �--- ----` -------- .= r--.... <br /> Owner's Name-------- ---- -------------------------------------- --- - - ---.- Phone------------------------------------ <br /> Address ----------- <br /> Contractor's Name '-------- -------- - <br /> 'Q <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> i <br /> Number of living units: j---- Number of bedrooms -_ - Number baths -_�_ Lot size ----- --- ------ ------- ------ -----------_-.--_-_-__- { <br /> Water Supply: Public system [I .Community system ❑ Private Depth to Water Table _. <br /> + t- <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ElSa y Loam E] Clay Loam ❑ Clay E] Adobe Hardpan L]Previous Application Made: .(If yes,date_-----------;------- 1 No New Construction: Yes Dj?'No ❑ FHA/VA: Yes ❑ No 2--- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.)f <br /> �� ......----------------------- <br /> Septic nk: Distance from nearest well....- Q_...Distance�rom foundation....................Matt nal <br /> No. of compartments-.-__--_ �........._ depth_._.------- --------Capacity__45_0 L <br /> Disposal ield: Distance from nearest well.._......Distance from foun tion-.---Id____..---Distance to nearest lot line-------- ------- <br /> Number of lines -_;�- ----Length of each .line.. .-----� ------ ---...Width of.trench---------�--------------------- <br /> Type of filter materialo-P7 Ac_Depth of filter material--__._ ...-------Total length----------M _-. -------- <br /> P I I <br /> E <br /> 5eepag 'Pit: Distance;+o nearest well____ ____-_.Distance fr m f undation___/_+��_._____....Distance +o nearest lot line lel __._ :4...._..._ <br /> ❑' Number of pits_ -.c52------------Lining material--- �... Size: Diameter_._,4_3-----------Deptn___.... �_---_________ ` ' <br /> ii <br /> 3 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):---1-vew ---- ---------1� <br /> -----------•-------- <br /> ----------- -----------------------t <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, Sfa a laws, and rules and regulations of the San Joaquin Local Health District. . <br /> I {Signed}._-._ __ _ _ - -- (Owner and/or Contractor) <br /> BY .� - --------- --------------------------------------(Title} -- 4'f-t. ? <br /> (Plot plan, showing size of lot, location s em in relation to wells, buildings,s, etc., can be placed on reverse side}. <br /> FOR DEPARTMENT USE ONLY <br /> - - -2-6 ..9-�----- ---- <br /> Y APPLICATION ACCEPTED,BY------- .� .-.._-_-._------------ - ----- DATE-----1� <br /> REVIEWEDBY----- ----------------=-- ------------------------ ------ ----------- -------------------------------------- ------------ DATE----- --------------------------------------....------------ <br /> BUILDINGPERMIT ISSUED-------- -- --------------------- ----------------------------- ---------- --------- ---- DATE--------------------------------------------- --------------- <br /> Alterationsand/or recommendations:-- --------------- - -------. ---------- --- ---------------- ---------------- ------------------------------ --- -----•------------------------------- <br /> t ------------------------- <br /> ------- <br /> ------------------ ------­­--- ----------------I-- - <br /> -•...............................................I-_.-_----------------------- ----------- - ----------- ------------------------I------------------------------ -------------- <br /> ------------._...._- ---'"-----------------------._._....-----._.......--------.....--------------------------...-.-..-.------- ---------------------------- J <br /> ------------------------ <br /> --- ------------------- <br /> --._._...----------_._------------------ <br /> _-.---------------..-._..-.----_.....--._..-...__.-.._-.._-......--.----...._._._.__.--------_-_-_---- -----.--- <br /> �' r <br /> FINAL INSPECTION BY:..._ Date.... ' ............... ------- ----- <br /> I SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi. California Manteca,California Tracyr California <br /> E.H.9 2M 1-67 Vanguard Press <br />