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FOR OFFICE USE: <br /> -------- --- ---- ---- -- <br /> - <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------ -- - ---- -- � (� <br /> ----------------------------- -------- -- ---- ---- (Complete in Duplicate) <br /> ---.-_'_l' ___ 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 and install the work h rein described. <br /> This application is made in compliance with County Ordinance No. 54.9. <br /> ii 4 ] % <br /> JOB ADDRESS D LOCATION_____ _-p/ •l�Yt.�Q...�___C _.__-_____ <br /> �! t <br /> --- ---------- ------ -------------------I----------I------------ <br /> Owner's Name_ aa.�- --A-------- -------- - Phone------------------------------------ <br /> --�$ il- is .� w s + , <br /> y -- . <br /> Contractor's Nam __ _�__. -_ _�_� �. _ _ __ ____ _�-��F'sr�'�...��_--__.. <br /> Installation will serv �Z <br /> e: Residence Apar ment House' Comme Trailer Court Motel Other <br /> Lt1�p �N _ ❑ ❑ �C /� ❑ <br /> Number of living units: �. Number of bedrooms . umber of baths J.- Lot size „��_________________ __�__�__---..-..-__--__ <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _____ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ <br /> Previous Application Made:. <br /> (If yes date_..................) No ❑ New Construction: Yes ❑ No.1 ' FHA/VA: Yes ❑ No ❑ <br /> I TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> i Distance from nearest well---- ---------Distance from foundation____._._.__________.Material__.___.______.______._.____-__-____.:.________. <br /> No. of compartments--------------------------Size--------------------------------Liquid depth------------- - -------- Capacity---------------------- : V <br /> E <br /> 04 <br /> D• a d: Distance from nearest weli.�{��_Distance from foundation___*Z_P.__._..Distance to nearest lot line--_�+..--- <br /> Number; of lines- ._ Length of each line----e�V - ----_ Width of trench__2_��`......_ <br /> Type of,filter material_'9 p Gas <br /> '� { _ .._De Depth of filter material____ T .__..__._Total length___.______________��----------- <br /> 4- <br /> Seepage <br /> ________- <br /> ,. <br /> Seepage Pit: f Distance to nearest well_______________ -----Distance from foundation------------------- Distance to nearest lot line__._-_---___.__.. , <br /> ` ❑ Number of pits----------------------Lining material--------------------.--,Size: Diameter.----------------------Depth--.-------------------- - <br /> Cesspool: Distance from nearest well_________ ______Distance from oundation____.______._____.Lining material__._____________._..____.._'_._____:_ <br /> ❑ Size: Diameter---------- ------ ------Depth- -- `�......................... ------ ----Liquid Capacity- -.-------------------- gals" <br /> ' .__ <br /> Distance from nearest wel-----------------------------------S_. .-•_...._Distance from 'nearest buildin) <br /> Privy: ) �; - --��'; ..,,, g -- ---- - - - <br /> ( ❑ � Distance to nearest lot line --------------------- -""•=-•;---=-==-_•-�--�-------------T--'------. - --- �-- --------------------------------------- <br /> Remodeling and/or repairing (describe)-- ------- _ _ .--------------------------------------* <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, St to las, and,rules and regulations,of-the San Joaquin <br /> + ' <br /> Lealth District. <br /> faContractor) <br /> ----- - -- --- --- ��-------- ------''"-`----{s neo) <br /> E <br /> i By:----------------------------------------------------------------------- ------ --- -- - -- ------- {Title)------------------------- - -------- -------------- <br /> (Plot plan, showing size of lot, location of system in rel ion to wells, buildi , etc., can be placed on reverse side). ` <br /> FOR DEPARTMENT USE ONLYAPPLICATt <br /> I ACCEPTED, BY------------ , --------------=-- ----------- - DATE------ / ------- <br /> REVIEWEDBY 1--------------- ------- ------------ ------------------------------------ DATE------------------------------------------------ 4 <br /> r. <br /> BUILDINGPERMIT ISSUED---------------------------------------------'---------- --••--------------------- `--------------- DATE---------------------------------------------------_---------- <br /> n Alterations and/or recommendations_____________________ ' <br /> - ------------------------------- <br /> ------------------------------------------------------------------------- -- ---E---------- ---------- - <br /> -------------------------------------------- ---------- - - -----------------------=--- <br /> FINAL INSPECTION BYi�... `_-_.�_�_._ �J Date------ ��7 ------ ----------- <br /> ti <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ` 1601 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 /> h <br />