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FOR OFFICE USE: <br />-------------------- - -- <br /> -- ------ --------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> ----------- ------------ (Complete in Duplicate) Date Issued <br /> ----------------'=-------------------- This Permit Exeires. 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Healih District for a permit to construct and instal4 the work herein described. <br /> This application is:made in compliance with County Ordinance No. 549. of — 170(_-07 <br /> ( .."V -A-4r" 't 111' -----1 <br /> -------------- <br /> JOB ADDRESS AND CATION ------------ ---------- <br /> 4 re-------- ---------------------- .... Phone------- <br /> Name--------------- ---------------- --- <br /> 7,� ---------------------Q�- ---------------------------------------------------------------------- <br /> Address----------------------- ---- ------ ------- <br /> Phone----------------------------------- <br /> Contr6ctor's Name--------- --—--- <br /> Installation will serve: Residence Apartment House f-1 Commercial E] Trailer Court 0 Motel E] Other El <br /> h Lot size <br /> .......... <br /> corns -3---- Num�epth <br /> -------------- _. <br /> Number of living units: J--- Number of bedrooms baths`_-'--- 4rJi��� ? 64 <br /> Water Suppiy: Public system ❑El Community system D Private t Ater Table -------- ft. 1�� <br /> Gravel F-1 Sandy Loam Loam [] Clay [] Adobe [j Hardpanqj <br /> Character of soil to a depth of 3 feet: Sand E] <br /> Previous Application Made; (If yes,date_.__.._..----. No F1 New Construction: yes [] <br /> No FHA/VA: No Ell <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: I <br /> No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest weli t - --------4 <br /> Dis. ance from foundafion---------I---------Material---------------- -------------- <br /> -------- <br /> No. of compartments----- ------------ -----Size--------------------------- ---Liquid depth---------- ----Capacity----------- ------- <br /> Disposal d: Distance from nearest well------f'.,?.......Distance from foundation-----Z_q.........Distance to nearest lot line---------------- <br /> Number of lines------------I---- -----------Length of each line----- -----------------Width of trench---.-Z--------------------------- <br /> -------/-%-!"--_-Total length........ --------------------- <br /> Type of filter me ---------Depth of filter maferia <br /> Seepage Pif Distance to nearest well--___._._____- ----Distance from foundation--------------------Distance to nearest lot line__.________------r <br /> T -1 Number of pits----------------------Lining material-----------------------Size- Diameter---------------------A Depth------ -----------------------I i <br /> El , on--.-'.------------- Lining material`.______--------------------------7 <br /> Cesspool: Distance from nearest well-----------------Distance from founclati <br /> El Size, Diameter----------------- -------------------Depth----------------------------------------------------Liquid Capacity---------------------- <br /> -----9a <br /> Privy: Distance from nearest well-----.---------- --------------------------- ----Distance from nearest building_-_____________________________- <br /> Distance to nearest lot line------- <br /> -------------------------------------------------------------------•--------------------------------------------------------------- <br /> ❑ <br /> ---------------------------------- <br /> Remode4ing and/or repairing [describe):--------- ---------- -------- ------ ----------------------- ---------------------- ----- <br /> ------------------------------------------------------------- ---------6L-4 ------ ----------- --------- --- - ----------------------------------------- <br /> ---------------------------7-------- ------------------------------------------------------------------------- ------------------------------------------------------------------------ ---------------------------------- <br /> ------------- <br /> ----------- -------------------------- - ------------------------------------------------------------------------------------------------- __ __ - - - in accordance- - -- - -_w-ifh-_Sa-n-_Joaquin­Coulnty <br /> I hereby ci�rtify that I have prepared this application and that the work will be done <br /> ordinances. State laws,dan rules, and regulations of the San Joaquin Local Health District. $ppRtrW,and/or Contractor) <br /> .......... <br /> (S*Lgned)."----------------------- --------------- ----- ------ ---- --- --- ------ -------------------------------------------------------------- <br /> —- ------------------------------------ ---------- ------------------------------ - ----- --------- <br /> (Title) <br /> By:-------------------- - - ---- -- --- - <br /> -------------------- .. ............. <br /> . . <br /> (Plot plan, showing size of lot, location of system n relaflorto-wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> ----- - -- ------------------------ <br /> APPLICATION:7ACCEPTED BY--- - - -------- - ----- --- -------------------------------------------------- DATE0772--f --- <br /> 4_7 <br /> REVIEWED BY--- ---------- -------- ---- - ----------- __------------------------------------ ------------------------------ <br /> -------- DATE------------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE----------------------------- ------------------------------ <br /> Alterati6ns and/or recommendations:___-________________ _ ------------------ <br /> --------------------------------------------- <br /> --------------------------------------------------------------------------------------------------------------------- <br /> -------------- --------- ----------------------------------------------- ------------------ <br /> --------------------------------- --------------------------I----------- <br /> --------------------------------- ---------- --------------------- -------------------------- ----------------- ------------------------ <br /> --------- --------------------I------------------------------ -------------------­­----------I------------ -------------------------- ---------- ------- -------------------------------------- -------------------------- <br /> ------------- ------------:­­_............­----------­-------------I----------- -------­------------------------------- ---- ------------------------------------- --------------------------------I---------- ----- <br /> FINAL INSPECTION BY:_4:�Z, ---------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Lodi,California Manteca,California Tracy,California <br /> Stockton,California I <br /> F.P.CC. <br />