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FOR OFFICE USE: <br /> APPLICATION FSR SANITATION PERMIT Permit No. <br /> �..: ------------------------ ----------- �, <br />-------------------------------------- ------- (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 County Ordinance No. 549, <br /> JOB ADDRESS AND LOCATION. L <br /> Owner's Name ' �" t 1 -------------- Phone.----------••------------------- <br /> Address............ Z_121 "- - �r <br /> Contractor's Name------ ----- ----• --------r ------------------- -------- ------- -- -------------------------------------------- Phone.---------------•--..--_ <br /> Installation will serve: Residence ®—Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: .. 1- Number of bedrooms ---1---- Number of baths ./.----- Lot size ----- --- -------- -------- ------- ------------------------ <br /> Water Supply: Public system Ri—Community system ❑ Private ❑ Depth to Water Table�C.7ft <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 New Construction: Yes ❑ No RT" FHA/VA: Yes ❑ No d� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> ,(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> SepticsDistance from nearest well.................Distance from foundation----_------------ Material ....................___.___ _ <br /> ._..____ ---------- <br /> � <br /> ..Eck� . <br /> f No. of compartments-------------------------Size-------------------- -----------Liquid depth -------- ------ ------- Capacity---------------------- <br /> Disposal Fi I Distance from nearest well.-_----__Distance from foundation-_&............Distance to nearest lot line-�._.-._.... <br /> EIMAVI Number of lines---i.......�._---..__-..--_____Length of each line.--ID ..............Width of trench-_- �.�-.-�'------------. <br /> Type of filter material...�_L__Q-Gtr-----Depth of filter material---/ '.............Total length-.___-1-0---`------------------------- <br /> Seepage Pit: Distance to nearest well_____""'-:.-......Distance from foundation.-.A0_-----.....Distance to nearest lot line.477J..-_-- <br /> 2r Number of pits... -I Lining materiaL_r_jRt-:;;r _r_ Size: Diameter.--!33:X........Depth--- -------- <br /> Cesspool: Distance from nearest well ..._---..-._-.Distance from foundation_________________ _Lining material-----__-----__-----.----------------- <br /> ❑ Size: Diameter- - - ----- --- - ---------Depth---------------.------------------------------------Liquid Capacity-------------- ------------gals. <br /> Privy: Distance from nearest well...... ..........---..-------- _-_-------..----Distance from nearest building---------------------------------- _.__-- <br /> ❑ Distance to nearest lot line ------- --------------- -- ---------- --------------------------- ------------------------------------- -------- ---- ---------------- <br /> Remodeling and/or repairing (describe) ------------------------------------------------------------------------------------------------------------------------ <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, State laws, and rules and reg tions of fhe San Joa uin ocal He Ith District. <br /> (Signed)----------------------------- ------------- -----------C ................... ---- - --• ----- -------------------- --------(Owner and/or Contractor) <br /> By:------------------------------------------------------ ----------------------- ------- -- --------- --- ------_-- ---------.--.(Title)----------------- -- ----- ------------- ------ ---- -- <br /> (Plot <br /> - - <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY- --------------------------------------- ---- --------- DATE---7... a7-..` " ------------------ <br /> REVIEWED BY------ ------ ------- -------------- --- --- -------- ---- -------- DATE.. <br /> BUILDING PERMIT ISSUED----------------------- ------------------ ---- ----- = . _- <br /> DATE ----_. <br /> Alterations and/or recommendations /12/ <br /> -..263_. ------------------ ' <br /> •------•-- -----------•---------------------------• --------------- ---- ----------------------------------------------------------------------------------•------------ - -------------- --------------------- ------ <br /> FINAL INSPECTION 6Y:.. -L...._---------------- -----------------=------ Date . r <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ha:etion Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi. California Manteca,California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br />