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FOR OFFICE USE: <br /> I ...................--------------_--------------------- - APPLICATION FOR SANITATION PERMIT Permit No. .` <br /> (Complete-in Duplicate) <br /> --- ---- - ---- -- ` <br /> --------- . -_ <br /> --- --- <br /> --------------------------- <br /> -- ---- --------- <br /> ---- This Permit Expires 1 Year From Date Issued <br /> Date Issued __ a_r ' <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 complian�eiwith (County Ordinance No. 49. <br /> EJOB ADDRESS AND L TIPN- ---4--�-1. -- •-- - - -- ----- ----------------------------------------------------•--------------------------------------- <br />�Owner's.�Nam __- -_---- -............ --------------- -------. Phone.�� -- -- - <br /> ��_7 <br /> Address------------------------------ j <br /> ----------------- ----------•------------ <br /> Contract6r's Name --- - Phone <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ I Motel [❑ Other ❑ <br /> ` r <br /> Number of-living units: --I-_Number of bedrooms . ..:_ Number of baths I-.-- Lot size .._cCZ�_,� _1.,�----------------------------- <br /> Water Supply: Public system 'Community system ❑ Private ❑ Qepth to Water Table ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel 0 Sandy Loam ❑ Clay Loam ❑ Cly ❑ AdobeX Hardpan C] <br /> Previous Application Made: [Ifyes date_. J No � New Construction: Yes ❑ Nop!�_ FHA/VA: Yes ❑ No X%N <br /> TYPE OF INSTALLATION -AND SPECIFICATIONS: <br /> (No septic .tank or cesspool permitted if public sewer is available within 200 feet.) q r <br /> 0. ­'fly /v <br /> Septic Tank: Distance from e _7 nearest welOVFA Distance from foundation__./�A. - Material <br /> No' of com artments_ --------------._ Size--- x_s Li uid de th_ � Ca C-� <br /> pq R -- - --- Capacity_._kb__. <br /> Disposal Field: Distance from nearest well--..... ..........Distance from foundation----_-_---------t-.Distan ce to nearest lot line----------------- <br /> Li <br /> ...---._-_--.__ <br /> ❑ Number of �linA!_.:�7---=:ate-. ___- Length of each line.- -------- -_--ti--------!._.Width of trench______________________ <br /> Type of filter material-------.1'""_!- --!i. bbpth of filter material__________ ________ Total length_--__._---.-__---_----------_---...__._._ <br /> Seepage Pit: Distance to nearest-well_:_.._ ..____ Distance fro foundation---------------.__ Distance to nearest lot line---------------__ <br /> ❑ Number of pits._ �._t.r"e" Lining m o aria!---------------- Size: Diameter------------I---------Depth--------------------------------- <br /> Cesspool: Distance from nearest w I --------------.__Distance from foundation-----------------.Lining material---------------- - <br /> Size: Diameter. be th:�---. - - ------------------- - _- - —' . <br /> ----- ----- --�- ----- --- - - ---------- --. Liquid Capacity- ------------------------------- gals. <br /> Privy: Distance from nearest weli.7---------------------------------------------Distance from nearest uildin <br /> 9-------------- --------------- ----------- <br /> ❑ Distance to nearest lot Ii <br /> # - - <br /> r1` - <br /> Remodeling and/or repairing (describe) -t ...E --------- <br /> - - --•- --- ----- ----- -- - <br /> _ - - ----__ --__-__---- <br /> - - - - - - - -- - - -- - - - - - - <br /> ---------- ------------ ---------- --------------------------------- - ----------------------------------- ------------------------------------------ <br /> I hereby certify t l have prepared is application and t t the work will be done in accordance with San Joaquin County <br /> ordinances, State law , a d rules �n reg at}-ns of the .San J quin Local Healt trict. <br /> (Signed)------------------ - ------- ------- ------- -�-- ------- - ---- -- -------------- ------(Owner and/or Contractor) <br /> By:--------------------= r <br /> - (Title) ----- ------- -------------. <br /> (Plot plan, showing size of lot, location of sysf4ii67inre ion to--wells biildingsi`etcT''can be place on reverse side). <br /> 1f <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY. --- <br /> r :__---------_---------------DATE------- <br /> --------------- <br /> REVIEWEDBY ------- --- --------- --------------------------- -- ------------------------------------- DATE----------------------- <br /> BUILDING <br /> ---•-•- •--BUILDING PERMIT ISSUED-------- -- ------- ---------- ---------------------------------------------.----------------------. DATE <br /> Alterations and/or recommendations:----------------- -- ------ --------------------- ------------------------------------------ <br /> a <br /> (-------------------- --------- - -------------------------------- ------------------------ ------- ------------------------------------------- <br /> I <br /> FINAL INSPECTION BY:--- --------- ✓:d_ .e Date---- <br /> =;— ---- -------------------- <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 /> E.H.9 2M 1-67 Vanguard Press <br />