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FOR OFFICE USE: •> "�" . <br /> i ---------------------------------------- --------------- �7 <br /> - ---_------. ---_--,----- APPLICATION FOR SANITATION PERMIT Permit No. _ ' <br />;r ----------------------------------------------------------- (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 and install the work herein described. <br /> This application is made'in compliance with Count Ordin ncg No. 544. <br /> JOB ADDRESS AND LOCATI N.------------------,° `?� ----- = <br /> --------------- ---• ------- -------­--------------- <br /> Owner's Name -_---------- ----------------- Phone------ -----------------•--------•-- <br /> -- -----------------------------------------. <br /> •--.._== <br /> Contractor's Name-----c --- 7 ---------------I---------------------------- ------- ----------------- ------- ---------------- Phone..----.._.-.-------------_---- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑. Other ❑ <br /> SOXIf �� <br /> Number of living units: A---- Number of bedrooms ___ _ Number of baths__f_____ Lot size ________ _______ ----_------_____________ <br /> Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table 6v ft <br /> Character of soil to a depth of 3 feet- Sand [] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E5- Hardpan ❑ <br /> Previous Application Made: (If yes,date...... ] No t❑' New Construction: Yes ❑ No 23— FHA/VA: Yes ❑ No ff5J <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: . <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Sept c ra Distance from nearest well--- Distance from foundation___________________Material _---------------------------------------------- <br /> No. <br /> .____.._._..___________..___..__- -_No. of compartments __Li uid de th_-__.___ .__._. __.._ Capacity <br /> p -----�----Size------------------ -• -- Q R ----------------------- <br /> Disposal iald: Distance from nearest well_. .r__._Distance from foundation_.14..-____._._..Distance to,nearest lot line__-_._____ <br /> I r q <br /> Number of lines___i.___-___.--------------------Length of each line_. &Q__--------------_----Width of french .-__..-.-...__..._____._ <br /> Rr�. <br /> Type of filter material_1;?.C_A1..--_.._._Depth of filter material___,l$ .......Total length......3a ___________________________ <br /> Seepage Pit: Distance to nearest well--:--__- from foundation-----6�1---------- Distance to nearest lot line_ ^.--_.__.. <br /> Number of pits.__!-----------------Lining material __?-y_C_A__.. Size: Diameter.-Z-3..........----Depth.........: --- _f_--________ <br /> Cesspool: Distance from nearest well ...............Distance from foundation___----_____----_ _.Lining material._..... ._-...____....___-_-.__. <br /> ElSize: Diameter- -- Depth 4 -------------------------------------- ----- Liquid Capacity----------------------------gals. <br /> '�k <br />` Privy: Distance from"nearest well_ __________________________!__- Distance from nearest building._-______.__..____.___-_.-----.. <br /> ❑ Distance to nearest lot line---- ------------- - ------------------------ - <br /> t r <br /> I <br /> Remodeling and/or repairing (describe)=----------- --------------------------- ------------•------------- i-------------------------------- -------------------------•---------•---------------- <br /> -•---------• ------------------------------------ ---- - - - - <br /> ------------ --=-- ---------------------------------------- -- ---- ------------------------------------ ---- --------------------------------------- <br /> -, <br /> -------------------------- -------------------------------------------------------------------------------------------------------------------------------------------- - ------------ <br /> I hereby certify that I have prepared this application and tha+ the work will be done in accordance with San Joaquin County <br /> I ordinances, State laws, a ,r res and , g lations of the San Joaquin Local Health District. <br /> I i <br /> (Signed) -- -------- ---------------------:_.._._.--------- -------------------•----------- --------- ---)Owner and/or Contractor) <br /> --------------- <br /> ---- ---------- <br /> --•---•--- ------------------------ ---------------1------ ---------------------------------------(Title).- -------------- ----------- -- ---- - r --------------- <br /> (Plot plan, showing size of lot, location of system in rela+ionito wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.-. -------------------------------------------------------- ------------.- DATE-----Idles147 <br /> REVIEWEDBY----- ------------------- --------- ---- -- ----- - ------------------------------------------------------------------------- DATE - <br /> BUILDING PERMIT ISSUED-------- -- ------ ---------- - ------------------- -------------- <br /> DATE----- ---------------------------- <br /> --- <br /> Alterations and/or recommendations:. 4s� -------------------------------- -----•-- •-----------•----------------- •--------------•------------- <br /> --------------------- ---------------------- ------------------------------------------- <br /> ----------------- -------------------------. -------- ------------------ ---- ------------------------------------ - - ---- -----------------------------l <br /> - ----- -- --------------- ------ -- ------------- <br /> - ---------------------- <br /> l f <br /> FINAL INSPECTION BY:.........1 ,r-- -=--------- Date...... <br /> SAN JOA UIN LOCAL"HEALTH DISTRICT <br /> "1601"E.'Huselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> ;<:, .,� <br /> Stockton;California Lodi, California Manteca,Collfornia Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br />