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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) DIssued <br /> r - d _ <br />� � This Permit Ex fires l Year From Date issued ' <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and installthe a wok herein described." <br /> T is application is made in compliance *ifh County Ordinance No. 549. <br /> q <br /> ,�,� <br /> JOB ADDRESS AND LOCATION­/ .��� .'---- -------------- - ---------------------------------- <br /> Owner's Name------- --------------- Phone---------------------------------- <br /> WA, <br /> ------------- <br /> ` Address------------------ °Jl ._ r' '!f-{- ---------------- <br /> Contractor's Name---------- ----- Phone <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ,_ 'Number of bedrooms _ - Number of baths .,/--- Lot size ---eg-A ----------•--------•-------------- <br /> Water Supply: Public.system ❑ Community system ❑ Private Depth to Water Table/(A_`ft. <br /> Character of soil to a depth of 3 feet: i Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Er Hardpan ❑ <br /> Previous Application Made: Yes ❑ No New Construction: Yes ❑ No FHA/VA-.'Yes ❑ No g- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic,, Tani: Distance from nearest well---------------_Distance from foundation-------------------,Material------------------------------.------------------ <br /> /�/l4f No, of compartme'nts'.----------------------Size--------------------------------Liquid depth--------------------------Capacity_--------------------- <br /> Disposall�Field: Distance from nearest well.................Distance from foundation_....._. -------- Distance to nearest lot-line--------------- <br /> iY�I f Number of lines,A -----Length of each fine Width of trench -: <br /> Type of filter material____-----_-_------_----Depth of filter material----------------- --Y-Total length------------------__-----__----_..._.._ <br /> 1 t <br /> Seepage Pit: Distance to nearest well___/fQ.---- Distance fr m found . <br /> ation_.... -__.Dista E� to nearest lot line . ------- <br /> Number of pits.___�_�.._- ....._Lining material--- iP .---Size: Diameter.,_�X..� �.. Depth____ . -----=----------• <br /> Cesspool: Distance from nearest well.- .._._Distance from foundation---------------- '.Lining material------------------------------------ <br /> ❑ Size: Diameter___A_;- -----------------Depth---- ----------- ----------Liquid Capacity------------------------_-gas. <br /> Priv Distance from ne'arest well-----------------------------.------.----------.-Distance from .nearest building--__-------------------------- <br /> ------------ <br /> . O <br /> ❑ Distance to nearest lot line--------------- ---- ------------- --- - ------------------------ ------------•------------ -------------------------------------------- <br /> Remodeling and/or repairing (describe)--------------- -------•--------------------------------------------------------------- C <br /> ------------------------------------------------------------ -------------- --- <br /> ---------------------- -------------------------- La <br /> I -------------------------------------------------------------=------------------------------ <br /> 1 --------------------------------------------------------------------- --------- <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 /> r <br /> , � I ----------------- �or Contractor] <br /> (Signed)--- <br /> ` ------------------- -----------(Title)---. ' <br /> i <br /> By:-------------------------------------- -------- <br /> (Plot plan, showing,:size of lot, location of em in relation toywells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY f <br /> APPLICATION ACCEPTED BY------- ------- ------ DATE------------------ ��`°----•--------------- -- <br /> ------ ---------- DATE--------- '-------------------------------------------- <br /> REVIEWED BY- -------------- - ----------------°- - ---- -- ---- - ----- -�----------- -- � <br /> BUILDINGPERMIT ISSUED----------------- ---- -- --------- DATE----_---------------------- ----- -------------_­----------- <br /> Alterations and/or recommend afions:----------------- ---- -----------------------------•-•-•--------------------------------•------------------------=-- <br /> r - ---------------------- <br /> --- - ---------------------------------- <br /> --------------------- <br /> -- ------------ •-•---- -- F <br /> -- ------------- ----- --------------------------------------- <br /> s. <br /> . � 140 <br /> " , . , . , --- ---------------------------------- <br /> -------------------------------- ---------------------------------------------------------- <br /> - <br /> -- ---- ----------------- <br /> Date---../ <br /> - <br /> l <br /> E FINAL ��INSPECTI ---- -- - Date-- - -' �--.�J.:"_-� -------- -------- <br /> k SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South Arherican=Street­ --t-3013-_300 West Oak Street ^+y 132 Sycamore Street 814 North "C" Street <br /> S Mantace, Celi�o�nia Tracy, California <br /> x.Stockton, California Lodi, California `r` 3 .'�t <br /> Es-9=2M '.k. - <br />