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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT Permit No. "--------- <br /> --------- ---------------- --- ----- ........ (Complete-in Duplicate) Date issued /--- <br /> ------..._ This permit Expires 1 Year From Date Issued <br /> !-',--- <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---- + -------�i---- <br /> Owner's Name--- ,e l------�/ 'rr ---••---------------------------- -------- -- ------------ --------- Phone------------------------------------ <br /> Address------------ +` '�--'---------- ---------------------------------------------------------------------------------------------------------------------------------- ----------••-------------- <br /> Contractor's Name------------���----- QQ -P�. ---------------- ------- -- -- - -------------------------------------- Phone------ ---------------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [] Other ❑ <br /> -_ <br /> Number of living units: .-_-- Number of bedrooms �. - <br /> Number of baths. A- <br /> .. . Lot size -- <br /> Water Supply: Public system ❑ Community system ❑ Private 9--6epth to Water TabIv,Q ft <br /> Character of soil to a depth of 3 fee+- Sand ❑ Gravel [-❑ Sandy Loam W4-151ay Loam 0 Clay ❑ Adobe �ardpan ❑ <br /> Previous Application Made: (If yes,date........... ...... 1 No [Lr New Construction: Yes [ o ❑ FHA/VA: Yes R;--No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> .00 <br /> Septic Tank: Distance from nearest welLl6%t9Distancelfr i foundation-� --.------Materiali��c� ........... .. <br /> 11 �� No. of compartments--.�...............Size_3X_6__`%Ze%?L1quid depth_%�_._ __...._Capacit, RWO W---_-_ <br /> Disposal Field: Distance from nearest well_/--ZQ__DVance from foundationaZ-p..........Distance to nearest lot line,7&--- ... <br /> Number of lines ----�_-./---------------Length of each line_-Fa. _�.............Width of trench_2-.-_ ----.-._--_--.------ <br /> i Type of filter materieflZ?,Q0-Depth of filter material_.�r'er.......Total length__ Q--- --__------------- Q <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation------------..-.--- Distance to nearest lot line-__-.----_----_ <br /> :I ❑ Number of pits--- ------------------Lining material------._.------------- Size: Diameter-,---------------------Depth ---------------------- <br /> cbsspool: Distance from nearest well ----------------Distance from foundation................. ..Lining material------------------------------------- <br /> ElSize: Diameter- - -------------- ---------- -----Depth- --- ----- - ---------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well_---................................._-___._._Distance from nearest building---.--..---------------------..------_-.-. <br /> .I ❑ Distance to nearest lot line ---------------------------- <br /> Remodeling and/or repairing 1 --------------------------------------- <br /> { ---------------------------------------------=-----•-------------------------------------------- <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 /> ,p (fir Contractor) <br /> (Signed) fff`/ d -. ^. ....... <br />` BY:-------------------------------- ---------------- ---- --- --- {Title) 1 _............... <br /> (Plot plan, showing size of lot, location system in relation to wells, buildings, etc., can be placed on reverse side). <br /> oe FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY- -- '-fie'-l--- - - --- -- --- ---------------------------------------------------- DATE---- --------------------------- <br /> REVIEWED BY------------------------- ----- -- ---- - - ----------------------------- <br /> ------ DATE----- -------------- ---------------- <br /> BUILDINGPERMIT ISSUED------- - --- ----------------------------------------------------- --------------------------- DA-TE-------------------------------------------- <br /> Alterations and/or recommendations----------------------------------------------- ----- ----------------------------------------------------------------------------- ----------------------------- <br /> 14 <br /> ------------------------------ - -- -------- ------------- --------------------- - --------------------------------------------------- --------------------------------- --------------------------------- --------- <br /> ------------------- -------------------11---­­------ -------------- - - ---- - ---- ------------------------------------------------ -------------- ----------------------- ----- ---..... ......... ---- ----I-- ----- <br /> = ----- ------------------------- --- -- - -------- ------------------------ ----- <br /> --------�---- - -------------- <br /> ------ <br /> -�FINAL INSPECTION -- - - --- ----- Date---------- - -- -------------- ----- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore street 205 West 91h Street <br /> I5 Stockton,California Lodi, California Manteca, California Tracy, California <br /> E.H-9 2M 1.67 Vanguard Press <br /> II " <br />