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F R OFFICE USE: <br /> --- - ------ --- -------- ------------- ----------- - APPLICATION FOR SANITATION PERMIT Permit No. 1 .. I <br /> �. <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 `with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCA N -1--! F-1�' -4----��"' 1 <br /> Owner's Name --- --�- - Phone <br /> ---•-----•-------- ------ - - ---- -------------- --------- ------ <br /> Address-•-------.. 0-r-44--- ------------I----------- -------------------------------------------------------------------------------------------------- <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 --.Z-- Number of-baths -/----- Lot size --- ,/_ -- -------------------------------- <br /> Water Supply: Public system [Community system [I Private ❑ Depth to Water Table _4, tt <br /> Character of soil to a depth of 3 feet Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeyardpan ❑ <br /> 7-_ <br /> Previous .Application Made: (If yes date.-..--..._..._-.... J No Z*'_New Consfiruction: Yes Q No FHA/VA: Yes ❑ NA. o•�—� <br /> TYPE OF, INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Sep ank Distance from nearest well--=-------------Dista n from foundation___ __P_.-____--.Material ---- <br /> Sep <br /> 4 of compartments..._'Z�:.---.-_-.._Size------------ .. _ ..____Liquid depth_-__-0....... .........Capacity.._- <br /> Disposa .Field: Distance from nearest well... ......Distance from foundation-------------- --_-Distance to nearest lot line----------------- -r <br /> ❑ Nurnber of lines----------------------------------Length of each line------------------------------Width of trench,__.------------------------------- <br /> Type of'frlter material------_--------------_-Depth of filter material____...------.--------Total length---- <br /> Seepage Pit:: .Distance to nearest --------------Distance from foundation-------------------.Distance to nearest lot line_____-_-.---..- <br /> ❑ Number of'pets'-- -----------------Lining material------------ -___.a Size: Diameter----------------------.Depth....................------- ----- <br /> Cesspool: Distance from nearest well _________________Distance from foundation____._____.__. _Lining material------------------------------------- <br /> El Size: Diameter. ; -Depth- --- ------ -----.LiquidCapacity----------------------------gal"s. <br /> Privy: Distance from nearest well________-----___---_-----__------- '_...__- -___-Distance from nearest building......._---------------------------------- ` <br /> ❑ Distance.,to.nearest.lot line------- --------------- ------------- - <br /> x <br /> /y/ <br /> Remodeling and/orrepairing (descril3e):-' -------�'C----- --- ��f--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, State laws, and-rit s and-regulations of thp San oaquin Local Health District. <br /> (Signed)--------------- ---------- - ---------- --------------------- ------- ---------- -- - -----(Owner and/or Contractor) <br /> By------ ----------------`-------------------------------------------------------------------------- ---------------------- -- -----(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 /> � R ' <br /> APPLICATION ACCEPTED BY-- T ----------- --=------------------- ----- DATE ---------------- <br /> _ <br /> REVIEWEDBY `-------------------------- -------------------------------------------------------------------------. DATE----.------------------------ <br /> BUILDINGPERMIT ISSUED-------- -- ----i------I----------------------------------------------- ----------- ----------------- DATE---------------------------------- <br /> Altera+ions and/or recommendations:----------------- ------------- --------.. ------------------------------------------------ ------------------------------------------------------------ <br /> r <br /> FINAL INSPECTION BY:-.-- . / Date.............;L_ <br /> ------ �• /"C <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ha>:elton Ave. 300 West Oak Street 124 Sycamore Street 20.5 west 9Th Street <br /> Stoikton,California Lodi. California Manteca,California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br />