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FOR OFFICE USE: <br /> - <br /> -------------------------------------------------------- <br /> �' APPLICATION FOR SANITATION PERMIT • 'Permit No. ��. .:::�6-fc <br /> ----------«-- ---------------- ----- -- (Complete-in Duplicate) <br /> Date Issued <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 install the work herein described, <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION --- -------- 7 <br /> Owner's Name------- -- -------------- Phone-- f -OJ_-3 - <br /> Address. Jf - -•- --- ------------------ <br /> ----- -- ------- -------------------------------------------------------------- <br /> 1 Contractors Name._. ! .-G-f.E. it✓-';' .r�'�'�`�1 �. .' °----------------- ---------_.-. <br /> Installation will serve: Residence [Apartment House ❑ Commercial.❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: A---- Number of bedrooms ;7--- Number of baths.R�__ 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 Hardpan ❑ <br /> Previous Application Made: (If yes,date_.-------__----.... ) No 5RO�'New Construction:-Yes ❑ No p��FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> eptic Tank: Distance from nearest well-----------------Distance from foundation__ -----------------Material ------------------_.-.------_-.---.-----_._----. <br /> No. of compartments------------- - Size---------- ----- - ---- ------Liquid depth---- - -- ---- - --- ----Capacity----------------------- <br /> Disposal eld: Distance from nearest well_))^Z Distance from foundation.�,�90.--_---..Distance to nearest lot line_s_r�__ <br /> a i I v <br /> Number of lines.____/_____ _'.�----______Length of each line--.--------l--__---__--r_..Width of trench__ _ _______.._.____ <br /> Type of filter material�_ ._YO�- k---Depth of filter material----. *.__`,�-Total length_---__._.,_____________•�___�____--.- <br /> Seepage Pit: Distance to•nearest well-,Cwr ---_Distance from #oundation_.=. �.I----- Distance to nearest lot line.-----.-.-- <br /> Number• of pits___ -./._.--......__Lining material__W_4_Clr`___ Size: Diameter.--70---..........Depth......-,R__4r-.-_-_.-.-_--.- d <br /> Cesspool: D-stance from nearest well ---__--_--__-Distance from foundation__:___________._ _.Lining material------------------------------------ <br /> ❑ Size: Diameter- ------------- - --- -Depth--------- ....................................Liquid Capacity----------------------------gals. <br /> 1 <br /> Privy: Distance from nearest wel6____-...__________________________...............Distance from nearest building-`__*__,,__._-___._.-._._-____.__.._-. - <br /> ❑ Distance to nearest lot Gne ------- _______ _ ------- - - ------------• <br /> Remodeling and/or repairing Idescribe)----------------------------------------------------------------------------------------------------------------------------- ---------------------------- <br /> I <br /> - F <br /> ---------- --------------------------------------------------------------__--.__-_-_.------------------------------------------------------------ ­----------------- ---- --------------------------------r--------- <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 t�e laws, and rules and egulations of the an Joaquin Local Health District. <br /> (Signed]____-_ (Owner and/or Contractor) <br /> �� �e--r�`! -- <br /> By:-------------------•---•-----.-- ----------- -- ----- (Title) ----------------- <br /> -------- <br /> plan, showing size of lot, location of system in relation to well buildings, etc., can be placed on reverse side). <br /> R ARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-.--- --- ----- - ------- ---------------------------- DATE------- <br /> REVIEWED BY------------------------- ------ --- - - - ---------- DATE--------------------------- <br /> BUILDING PERMIT ISSUED---------- - ------ ------------- - --- ------------- - -----------------------_ DATE----------- --------- --------------------------------------- <br /> Aiterations and/or ' omme dati3ms:----1-------------- ------ - <br /> �� C -- - -------------------- <br /> ---- -----------------------------------•--------------- ----- ------•------------------------------ <br /> k -- - - - -------- <br /> 1=1NAL INSPECTION BY: - <br /> �� 13 <br /> S�Af�JOA UIN LOCAL HEALTH DISTRICT <br /> Q <br /> 1401 E,Hazelton Ave. 300 Weil Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lad!. California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br /> 's - <br />