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rUK Ul-NICE USE: <br /> ---------------------- ----------------------- --------I <br /> ------------------------------------ -- ----___I_. APPLICATION FOR SANITATION PERMIT Permit No. .c�- a� <br /> I <br /> IM.. (Complete in Duplicate) <br /> --- ---- -- ------------------------------------------------- ---- <br /> 'N-- This Permit Expires 1 Year From Date Issued Date Issued <br /> - -=-/---- ----� <br /> Application is hereby made tl the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliant with County Ordinance No. 549. { I '• i V <br /> JOB ADDRESS A LOCATION. . _ ¢� {� <br /> Owner's Name - t = <br /> --------- ------ --- - honk: <br /> Address-----Z ------------ <br /> 1_. ._ <br /> l J r <br /> Contractor's Name-_--____ Phon <br /> - -• -- <br /> --------------------------- <br /> Installation will serve: Reside' ce Apartment'House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other E]I tom^ . <br /> Number of living units __�-- Number of bedrooms __umVDepfh <br /> baths __�ot size ___ <br /> Water Supply: Public system) ❑ Community system F1Private t ater Table ........ ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel ElSandy Loam Clay Loam E❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> jl <br /> Previous Application Made: Ilf yes,dote------ .-_ ,._} No El New Construction: Yes E] No E] FHA/VA: Yes ❑ No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if 'p ubilic sewer is available within 200 feet.) <br /> a5,a , <br /> Septic nk: Distance from nearest well___- <br /> ___---__---Distance from foundation-------/_ -------Material______ y+-" -__--------. <br /> Ff No. of compartments-------'�-�--------Size_f ���`_n$f_iif_cr�Liquid depth--------( ..�-_.- P y----- t <br /> Dispos Field: Distance from nearest well......,JrQ__Distance from foundation------/__Q_�_....Distance to nearest lot line��__ _-___ <br /> Number of links___________` --------------- -------Length of each line____�p..`_=-.7_U_'_.Width of trench -__ _____________________ 1 <br /> Type of filter material-.-- c c. -t---Depth of filter material___!_............-Total length----1Gt!------- _____________________•l <br /> Seepage Pit: Distance t nearest well ----- -----t--------Distance from foundation___-_---___-•____-.Distance to nearest lot line_________________ -�4, <br /> I <br /> ❑ ' pits----------------�.---Lining material-----------------------Size: Diameter---------- ------------Depth--------------------------------- <br /> Cesspool: Distance t om nearest well____y_:_ .�_.Distance from foundation,__----------------Lining material----------------------------------- <br /> ❑ Size: Diameter----------------------------------- Depth--------- ------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance fFom nearest well___---------------------------------------._----Distance from nearest building <br /> ❑ Distance to nearest lot line---------.__-___�--------------- - -------------------------------------------------------------------------------- -------------------- <br /> Remodeling and/or repairing 1{describe)----------------------------- -----------------------------------­_­-------------------------- -------------------•---------------...----------------- t <br /> --------------------------------------------------- ----------------------------------— <br /> ---------------------------------------------- <br /> Il ------------------- --------------------- <br /> -------------------- ` <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 laws, nd rules and regulations of the San Joaquin Local Health District. <br /> b <br /> (Signed)------------------ --------- ----------------------------------_- and/or Contractor) <br /> Plot Ian, showing size o -------- -- ---- - -- -- ----------- - Title <br /> ------ <br /> (Plot: g location of sys em in re ation to wells,�buildings, etc.,--can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY i <br /> APPLICATION ACCEPTED BY------ , - DATE <br /> REVIEWEDBY 1I------- -------------- ------------------------------- ---•------------------ DATE----- - - -------------------------------------------- <br /> BUILDING PERMIT ISSUED----�)----------- - ------------------------------- DATE----------- --------------------------------------------- <br /> Alterationsand/or recommendations:------------------------- - -------- -----------------------------------------------------------------•-------------------------------------------------------- <br /> ---------------------------------------------------=-------- --------- ---------- ------------------------------------------------------------------------------------- ------------------------------------------------•--- <br /> il <br /> -----•-- ------------------------- -------------- -------------------------------------- ----------------•-------------------------- ------- - ---------------------------------------- - - -- -------------------------- <br /> i <br /> FINAL INSPECTION BY: . 1 /ID �'�� � <br /> ---------------- ------ . -- -- <br /> SAN <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California ' <br />