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FOR OFFICE USE: <br /> ----------------------------- <br /> ------- ---------------------------------- ------ <br /> APPLICATION FCR=SANITATION PERMIT Permit No. �- ... <br /> -- ------------------------- --------------------------- (Complete in Duplicate) <br /> -_. __ .--- This Permit Expires 1 Year from Date Issued Date Issued �_.._______.. <br /> --- - 2 0�-: OSO—f <br /> Application is hereby made to the San Joaquin Loca! 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__ f &x___ j <br /> Owner's <br /> Name--------- .-------- �� ---------------------------- ------=-- - ------------------------------ --- - Phone--------------- -------------------- <br /> Address------R.Ill-------- ------2-1 --------------A/fcl -�---------------------------------------------------------------------------------------------•- <br /> Contractor's Name------------�� 7z- t ------------------------------------ --------------------------------------------------------------- Phone__.------------------_-------- <br /> installation will serve: Residence V]--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: I._-_ Number of bedrooms .3 -. Number of baths __1_-- Lot size ------.----.ffe.'r.-?.'`—_______________ C) <br /> Water Supply: Public system ElCommunity system E] Private [Depth to Water Table a_rft. <br /> Character of soil to a depth of 3 feet: Sand, Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan [3 <br /> Previous Application;Made:. llf.yes,date__.___.__.- 1 .No . New Construction:_.. _��Yes ❑-No FHA VA: Yes ❑ ...No ®1 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> l <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation-______----.------.Material---------____.____-_-_----._-_.-----.-.--------. <br /> `f/" - No. of compartments--------------------------Size--------------------------------Liquid depth r ------------------.Capacify--------------i------- <br /> `f/" <br /> Disposal Field: Distance from nearest well----S¢_-------Distance from foundation---/A---_____.Distance to nearest lot line___.___.__.__ <br /> Number of lines.--------I-----------------------Length of each line-----�ti.4-----r-------.Width of french.---2---._---------`--------_---- <br /> Type of filter material-_-_&ga.:/<___--Depth of filter material-.---Z1.__._____-_Total length------- _-�_a ------------- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation---___--_--_--_-_.Distance to nearest lot lin,e--------------- <br /> ❑El <br /> Number of pits----------------------Lining material---------- ------------Size: Diameter-------------------.---Depth--------------------------------- <br /> Cesspool: <br /> ------------ ------ <br /> Cesspool: Distance from nearest well-----------------Dista race from-foundation__------_.:-- L-fining-materia#_:.__:_ _- _--_ _. <br /> "` ----Li Liquid Capacity <br /> .. .r.. �❑ _�_:Size;•Diameter------ ---- Depth q gals. <br /> Privy: Distance from nearest well---------------------__--.-_.._-----------------Distance from nearest building..__-._____._____-----_----._._------� <br /> ❑ �. <br /> Distance to nearest lot line. - ----------------------------- --------------------------------------- ----------------------- ---------------- <br /> Remodeiirg and/or repairing (describe):--------------------------------- ------------------------------------------------- ------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- .-- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------- --------------------- <br /> 1 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/o�Contract7si}'� <br /> By:---------------r - -----------------------------------------------------------------------------------------(Title}------- ------------------------------ -- - ------- <br /> (Plot plan, showing size of lot, location of system in relation fo wells, buildings, etc., can be placed on reverse side). <br /> 1 <br /> FOR DEPARTMENT USE ONLY <br /> ¢ APPLICATION ACCEPTED BY.-- t- .-` ------ <br /> DATE �/ _ ------ <br /> REVIEWEDBY---- - ----------------------------------------------- -------- ------1-------------------------- ----- DATE-------- ------ ------------------------------------------ <br /> BUILDINGPERMIT ISSUED---------------------------------- ------------------------------------------------ ---------------- DATE------------------------------------------------------------- <br /> Alterationsand/or recommendaiions:---------7 -------------- -------------------- ------------------------------------------------------------------------------------------------------------- <br /> --------------------------­----------_----- <br /> ------------------------------------------------------_----- -------------•--------------------------- ------- ---------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------I--- ------------------------------------------- -------------------------------- ---------------------------------------------------------------- ----- --------- <br /> -------------------- <br /> ------ --------------------------------`-- <br /> -{-------------------------------------------------------- <br /> - - - - �------------- . ---- - - - - ----------- --- - - -FINAL INSPECTION BY Date--.------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1401 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.0 O. `' , .o <br />