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FOI�OFFICE USE: `//�' <br /> cE� APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br />------------------------ ---------- --------- Date Issued . <br />------ -- -------- ----- <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 d cribed <br /> This application is made in compliance Iwith County Ordinance No. 549. �. 1 -X <br /> pI �dX 7TH Pa77ys� d . �- -�_. q -------------------------- <br /> JOB ADDRESS AND LOCATION..----�-------- --------------- - - -------- �------ ------------ --- ---------- <br /> Owner s Name----- = -------------- ----- =®----- ----- <br /> -------------------------- <br /> Addre`ss----------- 1 �.. =`-"°="�_ � -7-f �`�`�..` ---------•--------•------------------------• ��� ��?� ., <br /> t ti. ` - ---•----------- <br /> Contractor's Name--------- � �--�--�--_ •---� "------ ------------ ------------------------ Phone.----•--•-----� F , <br /> g. <br /> Installation will serve: Residence �i`Apartment House ❑ Commercial ❑ ~Trailer Court ❑ Motel ❑ Other ❑ <br /> 1 6 14 --D 0--/------------------------ <br /> Number of living units: -1.__ Number of bedrooms - - Number of baths _ _____ Lot size ____.________________ _ <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 0 Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (lf yes,date--------------------) No [j- New Construction: Yes ❑ No E- FHA/VA: Yes ❑ No ©^ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: t <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ! <br /> Septic Tank: Distance from `nearest well-----------------Distance from foundation---------------=---Material_________________________________________________ <br /> No. of compartments-------------------------Size-------------------------------•Liquid depth--------------------------Capacity.. <br /> Disposal Field: Distance from nearest well_J'6__ .__. .Distance from foundation_-"f�___.___---Distance to neaiest lotiline_s ........... :...- <br /> Number of lines__-I------- ----------------------Length of each line---- -=---------------Width of trench-----=_- ------ <br /> .. <br /> I Type of filter material____ �'G-�<-------Depth of filter material-._._/-�'-- -------Total length------------------- N <br /> Seepage Pit: Distance to nearest well.__%-t'`_____.___Distance from foundation---.%o-----------Distance to nearest lot line ?' --------- pQ <br /> Number of ------Lining material-- /Qoc/C------Size: Diameter__._ _-�-------.Depth-----1- <br /> Cesspool: Distance from nearest weld_________________Distance from foundafion------------------- Lining material--- <br /> Depth -----------Liquid Capacity----------------------------gals <br /> . <br /> Size: Diameter-------------------------- ----- <br /> ❑� I Distance from nearest building, <br /> Privy:{ _. Distance from nearest well --------------------------- ------- 9 ;: <br /> ` -------- <br /> ❑: Distance to nearest of ine - ==s �` <br /> Remodeling and/or repairing IdescriSe)------------------- --------------------------------- •.:� �----------- <br /> ------------------------------------------ <br /> i -------------------------•---------------------. <br /> `t --- <br /> ---------------------- <br /> D <br /> - -------------------------------------- <br /> ----------------------- - - <br /> --------------------------------- - <br /> ------------------==----------------------- ------------------------------------------------------------------------------------------------------------------------ <br /> I hereby certify the+I-have p paw is application and`that the work will be done in accordance with San Joaquin County <br /> ordinances, S}ate laws,ia rules and regulations of the Son Joaquin local Health District. <br /> Sined / - ----------- ----- ------------ itl )---- <br /> ----.--___-(Owner and/or Cod tract <br /> ( 9 )------------- <br /> (Plot plan, showing sizeoflot, location of system in:relation fo wells, buildings, etc., can be placed on reverse side). <br /> t <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------- -------------------------------------------------------------- DATE ­T=// �i t <br /> REVIEWEDBY------------------------- ---------- -- -------------------------------------- ------------- ----- DATE <br /> BUILDING PERMIT ISSUED------------- t ------------ DATE----- ----------------------- ------------------------------ f <br /> _ rT . _ --------------------- <br /> Alterations and/or re omm�end'ations:—:_____�-__. ___________ ______ ____ <br /> -- -- � <br /> �'� ' � <br /> -- -------------------------------------- --------------------------------------------1-1------------------------------------- <br /> ----------------------- ---------------- <br /> -------------------------- <br /> ---------------------- -- --------- ------ <br /> ------ ---=------------ -" <br /> � Dated "....� r <br /> F1NAL INSPECTION BY:' - <br /> ----- o. .. <br /> - <br /> I :_,SAN JOAQUIN LOCAL HEALTH D15TRlGT , <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street j <br /> f <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> - � <br /> r <br />