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FOR OFFICE USE: <br /> :du'_------------ <br /> --------------------------- APPLICATION�FOR TANITATION PERMIT Permit No. -.�- � <br />............ =------------------------------------ (Complefe•in Duplicate) <br /> This Permit Ex ires 1 Year From Date Issued Date.,Issued, <br /> Application is hereby made to the San Joaquin Local Healtht District for a permif-to construct and install the work herein described. <br /> This application is made incompliance with County Ord-inance•No_.=549. i <br /> JOB ADDRESS AND LOCATION_.___ <br /> Owner's Name - ---------------------- Phone------------------------------------ <br /> Address ' x �� <br /> - -Contractor's Name Name------ _--7!9j0 --Wr -------------------- ----- - --------------------- ----------------- Phone------ ..-------------------------- <br /> Installation will serve: Residence W2- partment House ❑ Commercial ❑ Trailer Court ❑ Motel 0 Other ❑ <br /> Number of living units: _/_ Number of bedrooms _ _._._ Number of baths /._ Lot size° ' _1 _ __�___________________ <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to-Water Tab1e4dQ ft,_ , <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ GIay-Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: (If yes,date.---_ l ----------- I No.2�--New Construction:�Yes E] No FHA/VA: Yes ❑ No ®.— <br /> I <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: j <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I <br /> Septic Tank:/ 0.1 Distance from nearest well-____---------____Distance from foundation....................Material ---_------------- <br /> A1111 .._____...___�.. <br /> 1st Otf No. of compartments----------------------..-S;ze--------------------- -----------Liquid depth--------- ------- ------- Capacity----------------------- <br /> Dis osa�Fieldy Distance from nearest well:..`.;_...__....._Distance from foundation--------------------Distance to nearest lot line____._________... \� � <br /> Number of lines---------------- '- _y------Length of each line-- ---------------------------Width of trench---------------------------------- <br /> 7 Type of filter material._..F1__...............___Depth of filter material-' ________________Total length___--_-___________.____________________-_ <br /> Seepage Pit: Distance to nearest well..._ '?__-.._Distance fr m foundation__. _ ----------------------------------------- <br /> e !to—to nearest lot lines .___ <br /> Number of pits--- -- --------_--Lining material-/'7A Size; Diameter-- --- Deptn� --_---------------- f <br /> ❑ Size: Diameter_ _. t <br /> __Distance from foundation._......,__.____._.Lining material-_._.:._____-------_ _______________ 4 <br /> Cesspool: Distance from nearest well l Depth ` .Li Liquid Capacity- ' <br /> ---- p ------------ q p Y- --------------------gals. <br /> Privy: Distance from nearest well --------------------------------- <br /> __-----------__Distance from nearest building----._.______._-.____________.________-- t <br /> ❑ Distance to nearest lot line----------------- ------ --- --- -------- w` <br /> ,.. <br /> Remod ing and/or repairin (describe):-------..... --_____----.- <br /> w <br /> .._ ..__ ____ __ _ _ _-____. _ __ ..._-. <br /> Q _ <br /> ------------------------ - -------------------q--- ------------- # <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed) 9v -------- -------------- ------------------ 9(�or Contractor) <br /> BY a---------------------(Title) /. . .. . -------------- <br /> (Plot plan, showing size of lot, location of syst in relation to wells, buildings, etc.,'can be placed on reverse side). <br /> a k <br /> FOR DEPARTMENT USE ONLY ; <br /> APPLICATION ACCEPTED BY ------------ - ------------------------------------------- ---- --------- DATE_... "-... <br /> REVIEWEDBY---------------------------------------- ------- -- ------------------------------------------- - - ------------------------- DATE------ -------------------- <br /> `"------------------------------- F <br /> BUILDING PERMIT ISSUED-------- -- '------------------------------------------------------ --------- DATE--------------------------------- i <br /> Alterations and/or recommendations:----- -------------------- ---- -------------------------------------------•- ) <br /> --------------- ----------------------------------------------------- ---------------------------- k------------- ---------------- -------.---------------------------- <br /> -------------------------------- ------------------------------------------------------------------ ----------------------------------- --- ------------------------------- <br /> -----•-------------- -------- ------------------------------- ---------------------------------- --- ----- ----------------------- ........- - --- -------F <br /> ......-----........ . . ... ------ -- ----.--- ------ ---------------- ----------------- ------ ............. ...... -- .............. -- -- ---- ------- <br /> FINAL INSPECTION BY:.. -''-(!- Date-- <br /> SAN DISTRICT/OAQ' UIN LOCAL HEALTH <br /> - <br /> 1601 E.Iia:elton,Aw 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,C Iia fornia Lodi. California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />