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FOR OFFICE USE: <br />----------------- - --------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------------------- --------- --------- --------------- <br /> ....... .. ....... <br /> ------------------------------------------ ------------ <br /> (Complete in Duplicate) <br /> Date Issued ._J <br /> This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and instail the work herein described. <br /> This application is made in complian a with County Ordinance No. <br /> 5r49. --- - -- 0Z?— OZ.0-V-7 <br /> ---------- <br /> JOB ADDRESS AN ON � r --- - - --- --`- <br /> Owner's Name------- ------- ----------------- Phone-------------- --------------------- <br /> _ -Address.-•-------------- - - -- ----- ---------�-? ---------- •------ ---------- ------'------------------------------------------------------------------------ ------------- <br /> Contractor's Name-------- 0-- ___ -- -- -•------ <br /> ---- ---- --------------------------------- Phone_--.._..----•---------_---------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ p� <br /> Number of living units: /___ Number of bedrooms �2 Number of baths ___" Lot size _._____-._. ------ <br /> Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table -------- ft. �+ `JI <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam EKClay Loam ❑ Clay ❑ Adobe ❑ Hardpan <br /> � nk <br /> Previous Application Made: (If yes,date .......... ) No ❑ New Construction: Yes E-1No [:1FHA/VA: Yes E:1 No ❑j I �r] <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 /> ❑ No. of compartments-- -----------------_.--size--------------------------------Liquid depth----------- -------------Capacity------------------- <br /> Disposa field: Distance from nearest well---%..... .Distance from foundation_--lam_-____._Distance to nearest lot line__s-_ ..." <br /> Number of lines-------- ___________Length of each line------ -- -. <br /> -- _.-.._.Width of trench.-__ - <br /> .�____-___.___________ <br /> _ _____ <br /> Type of filter material-_ '? _!_____---Depth of filter material....-/-f ---___Total length____�.a--�_________________ _______ <br /> ____________________Distance from foundation___-..______--_-___.Distance to nearest lot line----------------- <br /> Seepage Pit: Distance to nearest well_ <br /> ❑ Number of pits----------------------Lining material_---------------------- Diameter-----------------------Depth-------------------------- ------\ <br /> il <br /> j. <br /> ____Distance,from foundation-----...__..- _ <br /> ----.Lining material---.___..._.--._ __.__-..-----______ <br /> Cesspool. Distance from nearest well___________ . <br /> ❑ Size: Diameter----------------- ---------------------Depth_,-------------------------------------------------Liquid Capacity----------------------------gals. <br /> l <br /> Privy: Distance from nearest well__-------.._i...--,___----_s___________________Distance from nearest building---.------_______-----________-._____.._. <br /> Distance to nearest lot line------------------ --------------------- ------------------------------------------------------------------- - ------------------- -- -- <br /> ❑ --------------- <br /> Remodeling and/or repairing (describe]:--- - ----------- <br /> --------------------------------------------------------------------- U ----------------• ------------------------•---------------------- ----------------------------- -------------- <br /> --------------------------------- --------------------------------------------------------------•------------------------------------------------------------------------------•---------------- <br /> I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws d rules and regulations of the San Joaquin Local Health District. <br /> (Signed) � ----------- ----- -- --------------------------- -------------------------------------------- t,and/or Contractor) <br /> gr - - ----- - ---------- ------ --------- <br /> (Plot plan, showing size of lot, location of system o relation t wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----------- DATE--- ------ <br /> REVIEWEDBY----------------------------------------- ------------ --------------------------------------------------------------------- DATE----------- ----------------------------------------------- <br /> BUILDINGPERMIT ISSUED-------------- -----=------------------------------------;-----'------------------------ ------------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:----- - --- -------------------------•------------------------------ ----------•------------------------•-------------------- <br /> -------------------- ----------"------- -----------------------­------------------------I--------------------------------•------------------------------------------•------------------------------------------------------- <br /> -------- --------------------------- -------------------- ----- ------------------------------ <br /> - - ----------------- --------------------- <br /> FINAL INSPECTION BY: -- - --------- <br /> SAN <br /> -------SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> I Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.CG- <br />