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FOR OFFICE USE: <br /> __ _ ______--_- . APPLICATION FOR, SANITATION PERMIT Permit No. .� . ..P. <br /> - - ------- ------- --------------- (Complete-in Duplicate) <br /> Date Issued <br /> _._ ........- ... ..... ............�- ______ ___ This Permit Expires 1 Year From Date Issued <br /> _ _ .: ✓`�- <br /> Application is hereby made to the San Joaquin Local Health District for a perrrvts o c-nstruct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION------- ' <br /> Owners Name ----------------- Phone <br /> Address------------1_3-'Z------- - _ - - ---------- <br /> Contractor's <br /> --------Contractor's Name----- 1-----'g--- ------------- --------------------- ------- --------------------------------------------- Phone......._--_--------------------_ <br /> Installation will serve: Residence Apartment House E] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: --I--- Number of bedrooms Number of baths_1-... Lot size _L4.6 __- ._------------------------____ <br /> Water Supply: Public system Eg—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 [e—Hardpan [] <br /> Previous Application Made: (If yes,date______..-____ _ 1 No [ 'New Construction: Yes [J-�No 0 FHA/VA: Yes ❑ No P�j— <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septi ank: Distance from nearest well-----------------Distance from foundation--------------------Material ------------------_____.._____-_----...__.---. <br /> No. of compartments--------- --- ---_....--Size-------------------- -----------Liuid de th____-_.__ ----- - Capacity <br /> -------- <br /> Disposal Fi�e�ld,'. Distance from nearest well--_-__....-----Distance from foundation------------- Distance to nearest lot line----------------- <br /> ❑ C "y"9 Number of lines---------------------------------Length of each line-- -----------------.--------.Width of trench----------------------------------- <br /> Type of filter material--------- _--- -----_---Depth of filter material.____---------___------Total length------------------------------------------ <br /> _ <br /> SeeDistance to nearest well........ .. <br /> _______Distance from foundation---.._--._._ _____ Distance to nearest lot line---------------- \4` <br /> � �✓ Number of pits- -----------------Lining material- ----- Size: Diameter--------- - <br /> Depth--------- ------------- -------- <br /> Seep e Pit: y �e <br /> 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 /> EJDistanceto nearest lot line--------------------------------�---- --------------------------------------------------------------------------- -------------------- <br /> Remodeling and/or repairing (describe :....0 ___L t G1'!* _ _____________ ___ - ? -(_------------------ <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 aws, and rules and regulations of the San Joaquin Local Health District. <br /> ---------- <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 /> APPLICATION ACCEPTED BY-IN.— .' ``^= - --------------------------------------------- --------- DATE__J.P_ -6--V --------------------------------- <br /> REVIEWEDBY------------------------------- ------------- ----- -------- ---------------------------------------------- --- ------------- DATE------- <br /> BUILDING PERMIT ISSUED-------- - ------. - --------- DATE----------------------- - ------- <br /> Alterations and/or recommendation __ _L ...rlA_.._-Cl`.......... ........... �ttf."1 .___ <br /> (y-, .,, n -- - ---- o-V <br /> ��V_Y.�31�.C.>�. _.. .. _ ,(D ,, — ��.p_ <br /> '--------------- <br /> - --------- .1� �, ----------------------------------------------------------- -- --- - ------ <br /> --------------- <br /> FINAL INSPECTION BY: ------.--. V --------------------- Date-- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.lfaieiton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi.California Manteca, California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br />