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FOR OFFICE USE: <br /> �.............. ....... ... - -............. ... .. .. APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete-in Duplicate) p <br /> I� .._._._ - This Permit Expires 1 Year From Date Issued Date Issued =__C...__lpd-- <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. 1 <br /> JOB ADDRESS AND LOCATION31c ' ► ------ <br /> er <br /> I <br /> Owner's Name I1 ��fid" '---------•----------- --------- - ------------------------------.- Phone------------------------------------ <br /> Address <br /> ----------------------------------- <br /> Address---------------------------------------- :7 --------- <br /> _ <br /> Contractor's Name e--- - -------- ------ dd/ Phone------ _---------------------- ' <br /> Installation will serve: Residence ❑ //Apartment House Commercial Trailer Court Mot <br /> P ❑ ❑ [� e! ❑ Other ❑ � <br /> Number of living units: _- ----- 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 ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,dote................... ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ ` <br /> - i <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <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 /> 1G1 No. of compartments-------------------------Size------••-- --------- -----------Liquid depth_.------. ----- . ....._. Capacity--------------------- <br /> i <br /> isposal FieYd: Distance from nearest well-.__._._._....._Distance from foundation___________---------Distance to nearest lot line----------------- {� <br /> A <br /> Number of lines----------------------------------Length of each line------------------------------Width oftrench_._........._.--..----------------Type of filter material_________________________Depth of filter material.....___._..__:_____._Total length_______.____-____________.___.----------eepa�e Pit:/ Distance to nearest well------_---------------Distance from foundation--------------------Distance to nearest lot line_____._____-__... O� I <br /> ❑ dumber of pits--- -----------------Lining material------.-------------- Size: Diameter.---_-.---- - ----Depth-----------------• <br /> Cesspool: Distance from nearest well ---------_------Distance from foundation___.__-.---------..Lining material_...------------- <br /> Size: Diameter_ _. ..._____ <br /> ❑ - --------------- Depth-------- -- ----------- - ---------- - Liquid Capacity- ------------------------gats. <br /> Privy: Distance from nearest well._- ----------------------------..._..._._____Distance from nearest building <br /> El Distance to nearest lot line-------------------------- --------------------------------- <br /> Remodeling and/or re airing escribe�:_ _-- - - --: ?43' --------- ` 1� <br /> !/ --- --- <br /> -------- --------------------- ---. � . <br /> FE cif fc <br /> -------------------------------- { _ G' - ----------- E--� fir- <br /> I hereby certif+`cfhat 1 have prepared this ap kation ari�Flat�ie 0.rk wiTi be done 0i <br /> n acc r a with- an Joaquin ounfy } <br /> ordinances, State laws, and rules and regulation of the San Joaquin L cal Health District. <br /> (Signed) ------------------------------- - - ----------------- <br /> 9 }-------�---�--- - ---------- ---------------------------------------_ (Owner and/or Contractor) <br /> BY= ----------------------------------- -------------------- ----•------------------------------[Title) -----....-..... i <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> j <br /> EPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----------- - DATE-- --- - --.1" <br /> �`'' <br /> REVIEWED BY------------------------------------- ,1.-.---------- ------- ------ DATE F <br /> BUILDINGPERMIT ISSUED ------------------------------------------------------------------------- --------- DATE-- --------------------- - - ------ ---------- - <br /> Alterations and/or recommendations:---------- ------ ---------------------- -------------- --------------------------------- -----------:---------------------------------••------------- <br /> --- --------------------- -----------------------------------------------•-------------------------- ------------------------------- <br /> I <br /> --------•---------- --- --- ---- --------------..-------- ---------------------------- ------- -- ------- -------------------------- ----------------- -------------- <br /> ------------------------------------------ -- <br /> _.. .... <br /> - <br /> 4 <br /> FINAL INSPECTION BY--------------- ---�--' -- -- - - ----- -- ----- --- [}ate------------=' <br /> A J AQ IN LOCAL HEALTH DISTRICT <br /> 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> i <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />