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FOR OFFICE USE: <br /> __ _ APPLICATION"POR SANITATION PERMIT Permit No. <br /> --------------------------- <br /> ------------- ------------------------------ - ------- (Complete in Duplicate) <br /> -_-_------�____---�� <br />------------ -------------------------- ----------- ---- __. I This Permit Expires .1 Year From Date IssuedDate 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-eompliance'with County Ordinance No. S49. <br /> JOB ADDRESS D LOCATION----- f�f - <br /> Owner's Name - -- -- Phone------------------------- ---------- <br /> Address----------- <br /> •--------Address-----__-.-•_ --- -- -- ---------------------------------------•--------------------------------------- <br /> - <br /> Contractors Name---- -/ � Phone <br /> Installation will serve: Residence ❑ Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _ ` Number of bedrooms _-J--_ Number of baths --a`---- Lot size ------------------------------0' <br /> 'Water Supply: Public system ❑ Community system ❑ Private Depth to Water Tablet. <br /> Character of soil to a depth of 3 feet: Sand E❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0' Hardpan ❑ <br /> Previous Application Made:`{iff r ,--elate:----___..=)' No ❑ New Construction: Yes [B' No ❑ FICA/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.) o. <br /> Septic Tank: 'C Distance from nearestje _--��- _Distance fromfoundation__._/___0---___._.Material_e_�_�__ ��-'---------------Is. , <br /> No. ofcompartments- ----- -_Size- de th_. i Ca acitD_ <br /> q p. p Y <br /> Disposal Field: Distance from nearest well - -----Distance from foundation..---------.Distance to nearest lot lin <br /> e_.__ <br /> Number of lines_____#__.--- ------Length of each line�W, __e "-.Width of trench-------------------- <br /> Type of filter material.,irAF c._.-Depth of filter material. ` .........Total length-40 �---------------_-Seepage Pit: Distance to nearest well_-/�w`___--Distance from foundation---/��_-__.Distance to nearest lot lined-:' <br /> [�' 1 Number of pits._.--------------Lining mate ria l___����_-Size: Dia meter-_��___.__.-----Depth� �igr1�� <br /> Cesspool: A Distance from nearest well-----------------Distance from foundation-------.-----------.Lining material_-.-_--__---_-__.__.______-_-_ ; <br /> ❑ J Size:;'Diameter------- ------------------------------Dept h---------------- - ------------ --------------------Liquid Capacity- -------------------------g <br /> Privy: Distance from nearest well ------------------------------------------------Distance from nearest building__________.________-_---__-_-.-.---_..._. <br /> ❑ r Distance to nearest lot line- -------------------------------- -------•-- ------------------------- ----------------------------- --------- - ------------------------- <br /> Remodeling and/or repairing (describe):------- ---------- ` v <br /> ------------- <br /> --------------- - - <br /> f---------------------------------------- <br /> ----------------------- ------------------------------------------------------------------------------------------------------------------------------ <br /> ________-_-_____-.-____ - <br /> ________________ S._______-.__.__-_--___________ --_-_______.__-________----_------_______---_-_- ---______--------__._----_________-__-__-____..-.---_---_____---------------- <br /> I hereby certify that I Ixavee prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws! and 'rules an• regulations o'f+fie San Joaquin Local Health District. <br /> --------- <br /> (Signed) -�f or Contracfiar), <br /> Y ----------- ----- <br /> i B buildings, --- ----[Title) l s ---------- <br /> (Plot plan, showing size f lot, location of system in relati o wells, g , etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------- -------------------------------------- ------------------ DATE- 4-S--' <br /> REVIEWED'6Y-------------------------------------- --------------------------------- - -------------------------------------------------- DATE--------------------•---------------•----------------------- <br /> BUILDINGPERMLT'ISSUED-------------------- ------- ------------------------ -------—-------------------------------- ----- DATE----------:------- -- <br /> Alterations and/off ecommendations:--) ----- ------ ----- - - . ------. .---- --- -- -+ <br /> -------------------� '' <br /> -------------------- --- ---------------------------------------------------------- ----------------------- -------- ----- -------- ---------------------------- <br /> ---------------------- <br /> ---------------------:---- I <br /> FINALINSPECTION BY;.,-O- ----------------------- Date------ '.t 4 4 .!P�.---------- ---------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1401 E.Ha:ellon Ave. 300 West Oak'Street s ,tet : .Ti , ; 124,Sycamore'S+re't I � 205 West 9th Street S <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.CO. <br />