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FOROFFICE USE; <br /> ---------------V d°A�"�_ <br /> APPLICATION FOR SANITATION PERMIT Permit No. . _ ------ <br /> -------------------------- <br /> -------------------------- ---------- -- ---- ---------- (Complete in Duplicate) p <br /> Date Issued <br /> This Permit Expires 1 Year From Date Issued <br /> Application is he,. - uu.,• �.'-n.Joaquin Local Healfh District for a permit to construct and install the work herein described. <br /> This application is made in comp)+once with County Ordinance No. 549. <br /> zi <br /> JOS ADDRESS AND LOCATION...... __-� -I - -------- ------ --- <br /> t - <br /> Owner's Name---- F------_ <br /> � ------------------------------------------------------------- <br /> Address---------A{PZ------- _ ---------- <br /> Phone____... ---_ _ J' <br /> Contractor's Name--------_______________-��-_______,, _ � � �'' <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> units: _ Number of bedrooms s <br /> Number of living A---- .�,-- Number of baths -f---- Lot size ---- `--------------------------- <br /> Water Supply: Public system ['Community system ❑ Private ❑ Depth to Water Table AP 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 Rj - New Construction: Yes [] No g—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 /> Septic Tank: Distance from nearest-well---&0-------Distance from foundation__./_Q__--.____-Material_____________________________~.__________- <br /> F / q+ 6 <br /> --------Size-----3_X-----? Liquid depth -4-,r .---- Capacity----� <br /> No. of compartments_______�. -_ � <br /> disposal Field: Distance from nearest well- VO-------Distance from foundation----r4__*-__.__.Distance to nearest lot <br /> ®_ Number of lines-----------4---------------------Length of each line--------i?_q----------_Width of trench------�--.---- ---.--.--------. J <br /> r <br /> Type of filter material_____�1G._ .__Depth of filter material----- length----------- 6-.6________________-_. <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------_Distance to nearest lot line----------------- W <br /> ❑ Number of pits----------------------Lining material---------- ------------Size: Diameter---------.-.------.----Depth--------------------------------- J�* <br /> Cesspool: is rom nearest well-----------------Distance from foundation-----------------_Lining material---------------- _._____---_--_-._- <br /> ❑ Size: Diameter---- - ------ --------------------Depth-- ------------- ------ Liquid Capacity gals. <br /> Privy: Distance from nearest well___._____.________________ ________________Distance from nearest building--------------.____.____________..___--- i, <br /> ❑ Distance to nearest lot Gne - ------------------------------------------------------ G <br /> Remodeling and/or repairing jdescribe):_._!----------------- ----------------- --------------- ---•-- -------••--------- - ----------------------------•--•------------- 0 <br /> ------­-------------------------------------------------------------I---------------------------------------------------------------------------------- <br /> --------------------------------------------------------- :--I------------------------•---------------------------------------------------------------------------------------------------------------------- <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 regulations of the San Joaquin Local Health District. <br /> (Signed) _ - ---- --- ------- -'}-----------------------------------------------------------(Owner and/or Contractor) <br /> By:----------- - ----- Title <br /> (Plot plan, showing size of.Iot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ---------------------------------- DATE------ -�- 741--------------------------- - <br /> REVIEWE <br /> ---------------------- - <br /> REVIEWEDBY--------------------------- ----------------- ------ DATE----------------- ------------------------------------ <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE--------------------------------------------- <br /> Alterations and/or recommendations:--------- ------------------------------------------------------ --------------•-------------------•-----------•-•---------------------------- <br /> ------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------•------------------- <br /> ----------- <br /> FINAL INSPECTION BY. --------- Date............�_�=66 <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 />