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FOR OFFICE USE: <br /> ----------------------- - --------------------------- - <br /> APPLICATION FOR SANITATION PERMIT Permit No. ...... ... <br /> =--------- -- -- -------------- --------- (Complete-in Duplicate) <br /> This Permit Expires 1 Year From Date Issued <br /> Date Issued <br /> _ <br /> -_-,.__-•------_____---.------- ----------------------- <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 Countyance No. 549. <br /> aX --------------------------------------- ----------------------------------- --------------------- <br /> JOB ADDRESS AND L�ClON.___ --.r--�----------------------- --- -Owner's Name ------- ------ lex% <br /> --- ------------- ------- Phone---------•---------------------•---- <br /> k Address----•--- ------ •------_.... <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 __._; Number of baths I--- Lot size -___'--. _------.-------- -------------------------------- <br /> G t <br /> Water Supply: Public system ❑ Community system El Private F-1Depthto Water Table .0 ft v . <br /> Character of soil to a depth of 3 fee+• Sand ❑ Gravel ❑ Sandy Loam ❑ Clay loam ❑ Clay ❑ Adobe [3'-Hardpan ❑ . <br /> Previous Application Made: (If yes,dote-------___------ ) No g4-" New Construction: Yes ❑ No VT'- FHA/VA: Yes ❑ No [�f— <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.)-. <br /> Sept' Tank. Distance from nearest well-----------------Distance from foundation--------------------Material ------............___.--..._---------.._---.__. <br /> No. of compartments------------------- - - Size--------------------- -----------Liquid depth---- ---- ------- --------Capacity--------------------- <br />' Disp 1 F' Disfance from nearest well---.—..._.-.-Distance from foundation--j' ------_.__-.Distance to nearest lot line----j-------.- <br /> Number of lines ------1--------------------------Length of each line__3d ---------------- of trench._._ �f._�_____.---_-_--_._ <br /> Type of filter materia4.- JG� --------Depth of filter material_._7S-.------------Total length______t' G_--_______________________ <br /> Seep e Pt Distance to nearest well-_._t--------Distance from foundation-__/Q----__.....Distance to nearest lot line-'5. ---.._- <br /> __._.Linin material-_._ _ G - Size: Diameter.--____3;�._------_De M---.-2 .................. <br /> Number of pFts--- .�--_-__-- g � �--- p <br /> r Cesspool: Distance from nearest well ----------------Distance from foundation.. ............ ..Lining material--_-.-_-_-_.-_----__.-.._--_.-.-. <br /> _ ❑ Size: Diameter. -- . . - ----------------Depth------------- -------- - ------------. ----------Liquid Capacity....------------------------gals. <br /> Privy: Distance from nearest we'll ------------------------------------------------Disfance from nearest buil&ng----------.-_._-_--._-_------.._---------- <br /> ❑ Distance to nearest lot line----------------------------- <br /> p Remodeling and/or repairing (describe): ------------------------- - --------------------------------------------------------- ------------ <br /> �. <br /> -------------------------- <br /> ------------------------------- -------------------------------------------------------------------------------------------------------------- ------- ------ ----------------------------------------------------- <br /> I hereby certify that I have repared this ap I' at' n and that the work will be done in accordance with San Joaquin County <br /> i ordinances, State laws, and rul a egulatio f e Sa Joaquin Local Health District. <br /> t <br /> i ------------------Owner and/or Contractor <br /> (Signed) - ( / <br /> Sy:-------------------------------- -------•-- - --- --- ----------------------------------- --------------------------------------(Title)---------------- ------- -- --------- - <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> nF <br /> ��� �- -�'------ - <br /> APPLICATION ACCEPTED BY----------- ---' --- -� --- -------------------------------------------- DATE------jam --------------- <br /> C REVIEWED BY------ ------ ------------------------- ------------- ----------- --------- ---------------------------------------•- DATE-------------------------------- -------------------------- <br /> iBUILDING PERMIT ISSUED-------- -- ----------------------------- ----------------------------------------------------------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations------- -- ------------------ ------_----- ----------- ---------------------------- --------------- -•------ ---- <br /> ------------------------- ------------------------------------ - ------- - - --------- -------------------------------------------------- -- ------------------•--------------- --------------------------------•---- <br /> --------------------- ............... -------------------------------------- --------- ---------------- --------------------- - ----- - ----- --------------...--------------- ------------- <br /> 1 <br /> 3 FINAL INSPECTION BY:-------- Date-------- l -_ - �� <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Nasellon Ave. 300 West Oak Skeet 124 Sycamore Street 205 West 9th Street_ <br /> Lodi, California Manteca,California Trac <br /> Stockton,California Y,California <br /> r <br /> i E.H.9 2M 1-67 Vanguard Press <br />