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FOR OFFICE USE <br /> ------------ <br /> . APPLICATION�FOR--SANITATION PERMIT, Permit No. � <br /> a <br /> (Complete—in Duplicate) <br /> -- _ — <br /> �}. __—_�__D__ <br /> This Permit Ex fres 1 Year From Date Issued ""` Date Issued <br /> ............ <br /> .............r---- ---....__._..._-_-� -----.._. <br /> Application is hereby made to the San Joaquin Local Healeh District for a permit to construct and install the work herein describeid. <br /> This application is made in compliance with County Ordinance No. S49. <br /> JOB ADDRESS ANQ LOCATION_ .37- '--.---- ---------------------- <br /> Owner's Name---- `y` _ - ph <br /> ........ Phone--------------------------- -------- <br /> Address f'144-- ={ / <br /> - -= <br /> lContractor's Name----- - ------ i ----- ----------------------------------- ------- ------------•-------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence -_Apartment House ❑ Commercial ❑ Trailer Court '❑ Motel ❑ Other ❑ <br /> Number of living units: .?--__ Number of bedrooms Number of baths---J-- Lot size --. ._ __. -- ._---.-_.____________________ <br /> Water Supply: Publics stem 1 <br /> pp y: y Community system [� Private ❑ Depth to Water Table �.b ft <br /> Character of soil to a depth of 3 feet-- Sand ❑ Gravel 0 Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ <br /> Previous Application Made: (If yes,date------------------- 1 No [ New Construction: Yes R?I'No ❑ FHA/VA: Yes ET'No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:t <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> I Septi�k: Distance from nearest well-- .......Distance from foundation-_ o._r____......Material ---- r. ----�t� <br /> No. of compartments---- ---------------Size---_--- - - - --9---Liquid depth----4- ------.---_--- Capacity,>� <br /> 1 <br /> Disposal Distance from nearest well-.- ----------Distance from foundation---/P-- ------.-.Distance to nearest lot line---- <br /> Number of fines.f_-----1_--.._-__•----------•----Length of each line__._ �.'�-------------- Width of trench_._o2c. __------------------- \ <br /> Type of filter material-`9 0-C-.�C------Depth of filter material__._/_�........... otal length__�g_0o,�------------------------- <br /> V <br /> Seepage Pit: A- l <br /> Distance to nearest well------ from foundation-./4>-_ �_.'DistanceCto nearest lot line..___.._.._ 6\ <br /> [ � Number of pits.. . ------....._.--Lining material-__/r'lo -�� Size: Diameter.._--± �5_.``.__Depth__-..-. - - - <br /> ------------ <br /> i Cesspool: Distance from nearest well ----------------Distance from foundation................:_Lining material-_-.-_.--..----._.______-_.- <br /> ❑ Size: Diameter- -3-_.___.. <br /> ----- ----- Depth - Liquid Capacity. . gals. <br /> Privy: Distance from nearest well--------------------------------------------.----Distance from nearest building---------------------------------------_. <br /> ❑ - Distance to nearest lot line------------------------------------------- <br /> Remodeling <br /> --------------------------------------Remodeling and/or repairing (describe):....-- •---- ------------------ ••-----•------------------ < <br /> e <br /> --- ---------------------•-----------------•------------------------------------- .------ <br /> - -------------------- ---------------- <br /> ---------------------------------------------------------------------------------------------------- <br /> ---------- <br /> hereby certify that I have-prepared this application and that the work will be done in accordance with San Joaquin County 1 <br /> ordinances, State laws, and rul and regulations of th San Joaquin- ocal Health District, i <br /> (Signed}-------------------- ------------------ - --.---- --------- ------ ---------------•---------------- - -----------------(Owner and/or Contractor) j <br /> BY-----------------•--------------- ------------------------ ------- - -- ---------- ----------------------------(Title)----- ------------------..------------- ---..-------- - ----- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i <br /> t FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.__ T <br /> REVIEWED BY ,- r F ----- DA7E_ S' -- <br /> --- ----------------------- -- •-------- DATE---------- <br /> BUILDING PERMIT ISSUED-------- --------- ----------------------------- - --------•------------------------ -------------._ DATE - <br /> Alterations and/or recommendations:)......___...................... <br /> -- - - -- - ---- ------------------------------ -------------------- ---------- ------------------------ -- <br /> 1--------------------------------------------------------------------- -. <br /> ---------- ----- ----------------------7------ ------- ------------------- - -------- --------------------------------------- --------- -----•----- - <br /> -------------------- ------------- ----------------------------- <br /> ----------- •-------------- -- <br /> ------------------------ <br /> � E <br /> FINAL INSPECTION BY�-�� -------- - ----------- Date----- _41. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1401 E.Hazelton Ave. 300 West Oak Street \ 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi. California ` ! ' Manteca,California Tracy,California <br /> �. <br /> E.H.9 2M 1.67 Vanguard Press <br />