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FOR OFFICE USE: y <br /> -------------------------------------------------------- <br /> rcQ - <br /> --------------------------------------------- ----------- APPLICATION FOR SANITATION PERMIT Permit No. ... <br /> ------ ----- -------------------------------------------- (Complete in Duplicate) <br /> -------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued ___ <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct andJ ipstall the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. 2,2 9 <br /> JOB ADDRESS A LOCATION -- -------------- <br /> Owner's <br /> --- ___Owner's Name------ ; Phone----------------------------------- <br /> y - �� <br /> I <br /> Address-------- ------------- -- F s•-- ?=`-�------�------ <br /> �� <br /> Contractor's Name- r ---•------------------------------------ Phone..--------------------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __I_ Number of bedrooms __Number of baths ___/_ Lot size _____.17p_ l�_-. - ____f______________ <br /> Water Supply: Public system Community system 0 Private ❑ Depth to Water Table ________ ft. <br /> Character of soil to a depth of.3 fee Sand E] Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date.__.____..___._--- No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:'-f• r <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Se tic ank: Distance from* nearest well___---------Distance of�2 fl �foun�fiLi�ui ._,_�___..._�Ca act" <br /> No. of compartments_______ Size �` Liquid depth__._____ p y r_0'_ _ <br /> Dispos ield: iDistance from nearest well___""__._____Distance from fiundation-._./t€P__�----Distance to nearest lot lineX _• _ <br /> Number of lines_____ Length of eacl�e ___• �-:-�7�-Width of trench.._-_ ./-------------- --- 4' <br /> Type of filter mate___ria-______ __--'_Depth-of filter material_____If--'r-----Total length'_ . jr, __________________ `f <br /> Seepage Pit: Distance to nearest well____________________Distance from foundation___--_-.___._____..Distance to nearest lot line______.___.._---. r <br /> ❑ 'Number of-pits-_._-._----- `-�-Lining material-----------------------Size: Diameter------------------.----Depth-.------------------------------- <br /> Cesspool: Distance from nearest well--------------:__-Distance from foundation--------------------Lining material---------._____________________.___ _ f <br /> ❑ Size: Diameter-------------=------------------------Depath----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well------ ----------------- <br /> from nearest building----------------------------------------- <br /> ❑ Distance to nearest lot line-------------------- ------------------------- ---------- <br /> ------------- <br /> Remodeling and/or repairing (describe) } --------------------------------------------------------•-------------------•----------•---------=-------------- <br /> ----------•-----------------------------------------------•------• --------------------------------=---------------•----- -----------------•------------------------------------•--------------------------- <br /> - •----•-----------------------•---------•----------------------•- -------------------------------------------•--------------------------------------- <br /> ----------_____________________________________ s r R <br /> I hereby certify that.] have prepared this application and""'hat the work will be done in accordance with San Joaquin County i <br /> ordinances, State laws, a les and regulations of the Sa'n Joaquin Local Health District. <br /> (Signed)------------------------- --------------------- ------- `---------------------------------------------- /or Contractor) <br /> ---------------------- -t '2- - -------- ---- ----------------ITitle)-------------------------------x------ ----- <br /> (Plot plan, showing size Sof lot, location of system in relation,to wells uildings, efc., can be placed on reverse side). <br /> e I <br /> FOR DEPARTMENT USE ONLY F <br /> APPLICATION-ACCEPTED BY----- -- DATE------------��` -- ----` <br /> ------------ -- <br /> REVIEWEDBY------------------------------------------------------------------------------ ----------------------------------------.-.. DATE <br /> BUILDING PERMIT ISSUED---------------------------------------------------------------------------------------------------._ DATE---------------------------------------- <br /> Alterations and/or recommendations--- ------- ---- -- --------------------- --------------------------------•-----------------------•---------•--•--------------------------•-----------•-------- <br /> -------------------------•--------------------•---- --------------- --------------------------­------------------------------------------------------------------------------------------------- ----------------•---- <br /> ------------------------------------ ---------------------------------------------------------------------------------------- ----------------------------- ----------------- -------- ---------------------------- ------ <br /> Z., <br /> FINAL INSPECTION BY:.-- _ __...___- .p< ---------------- Date...... <br /> ___"� ` i -- <br /> -- ----- -- -- ---------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-S9 3M 3-'S3 F.P.pD, <br />