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FOR OFFICE USE: <br />------------ ------------------------- <br />............. <br /> APPLICATION FOR SANITATION PERMIT Permit No. ___cam -.1 3 <br /> ------ ----------------------------------- ------- <br /> - (Complete-in Duplicate) a Issued Date issued <br />---------------- - - --- -------- ------------------ _ <br /> _ This Permit Expires 1 Year From Dat <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 complia�n/ce with County Ordinance No. 549. j8� fO Al, Q� <br /> JOB ADDRESS AN OCATIONT - +�c:. t -- - _ -- --- ° --i� - �r -�r.�.---------- <br /> r <br /> Owner's Name--- ------------------------ - ----- Phone <br /> Address-------t --7�-1-----�' <br /> �-�-- ----------- ----•----------------------------------------------------------- <br /> ....---- --------•--- ----.. . __- <br /> r ` <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 _._7._/. Number f baths-,�-__ Lot size -._ ___ ________ ___--_.___.__.____-__________ <br /> Water Supply: Public system ❑ Community system ❑ Private De;'Clay <br /> Water Table _____ _ ft 47 <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes, ----------- ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: # <br /> _{No septic tank or cesspool permitted if public sewer is available within 200 feet. x � <br /> Septic Tank: Distance from nearest well_________________Distance from foundation-------------.------Material ........-------------------------- ---._____.__. <br /> ❑ No. of compartments---- ------- -------------Size-------------------- -----------Liquid depth-------- ------- ---------Capacity................... <br /> ._-• <br /> Disposal Field: Distance from nearest well.................Distance from foundation-_..----------------Distance to nearest lot line__________.____-_ <br /> ❑ Number of lines ----------------------------------Length of each line__ ------I----------------------Width of trench----------------------------------- <br /> Type of filter materia}__-- -__Depth of filter material----------------------- length_._.�___._-___-___________.._____________ <br /> it: Distance to nearest well- Distance from foundation_��_.._____.._. Distance to nearest lot line-__ -...._____ <br /> ❑ Dumber of pits--- -----/.......----Lining material----- 2Size: Qiarrn*IDepth--­/.- <br /> Q- ----_. <br /> Cesspool: I <br /> Distance from nearest well ________________Distance from foundation_________-____ ..Lining material__.__._____-._._____.___.____________ <br /> Q <br /> Size: Diameter- -- --------- ----- ----------------Depth------ -----+ -------- r--------- -------Liquid Capacity gals. <br /> Privy: Distance from nearest well_.......... - - ---------------------- <br /> ------Distance from nearest building--------------,--------=______..____._. <br /> ❑ Distance to nearest lot line .----------------------------------------- <br /> Remodeling and/or repairing (describe) ---------------------- =r <br /> -----•-------------------------------------------------- ------------- ---------------------------------------- _ = = ------------------------------ --------------- ------------- <br /> - -y <br /> -------------------- ------------------ ---- ------------•------------------ ----------- ---------------------------------------------------- •------- ---- ------------------------ ...... <br /> ---------- -- - --- -- <br /> I hereby certify that I have prepared this application and that the work willrbe done in accordance with San Joaquin County <br /> ordinances, State ws, and rules and regulations of the San Joaquin Local Health District.- <br /> (Signed)------------ <br /> istrict.- <br /> (Signed)------------ ---- --- - ----------- - -------------- -----------------------`------- =v and/or Contractor) <br /> gY� --- --- ---- -----'--- - Title)----------------- --- --- ----- ---------- -- ---- <br /> u -(Plot plan,'showing size of lot;location of system in iation to wells, buildings; etc., can-be-placed on reverse-side):— <br /> FOR DEPARTMENT USE ONLY?` { ! <br /> APPLICATION ACCEPTED BY---- � --------- �--------- DATE---- ~-- G- ------------------------- <br /> REVIEWED BY----- -------------------------------------- -_------------ ------------------------------ ---------------------------------- DATE__---------------------- <br /> ----------------------------------- <br /> BUILDINGPERMIT ISSUED-------- -- ------------------------------ --------------------------------------------------------- DATE--------------------------------------------- ---------- <br /> Alterationsand/or recommendations---- ------------------- ------------------- --- ---------------------------------------------------------------------------•------------------------------ <br /> ---------------------------------- ---------------------------- ---------------------- ---------------------------------------------- .-.-_..--------- -------- ----- -----------------------•------------------ <br /> ---------------- <br /> --------------------- ---------------------•--- ------------- ........... -------------------- -- - - -------- ------ ----------------------------- <br /> [ J <br /> FINAL INSPECTION BY ._ ---------- ------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore street 205 West 9th Street <br /> Slocklon,California Lodi California Manteca,California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br />--.�., 4 <br />