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FORVOFFICE USE: <br /> ---------------------- ------- -------------- ----------- / <br />' -----------------__-.__..-__ -_ ------ ----------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------ -- -------------------- ----- - - i (Complete-in Duplicate) <br /> --- --... . _ .-.....-__-.-----.--- This Permit Expires 1 Year from Date Issued Date 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 compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND OC TION__ . -- ------- - -— <br /> - - - - -------------------------- <br /> Owner's Name- <br /> ------------------------ Phone-------------------------------- <br /> Contractor's Name-------- <br /> ------------------ --- 1� <br /> phone_ <br /> Installation will serve: Residence Apartment House El Commercial ❑ Trailer Court ❑ ElMotel ❑ Other <br /> Number of living units:/.---- Number of bedrooms -7--- Number of baths-/-- Lot size ----- <br /> -z- r4-�.�- ---------------------- <br /> Water Supply: Public system E] Community system ❑ Privatex Depth to Water Table Za ft <br /> Character of soil to a depth of 3 feet- Sand Gravel Sand Loam Clay Loam Clay Adobe Hardpan <br /> I P r ❑ ❑ Y ❑ Y ❑ Y ❑ ,❑ <br /> Previous Application Made: {lf yes,date_.--------- ------ } No 0 New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br />'.�—_...�(No-septic,tank-or-cesspool-permittedlif=pub lic-sewer-is-available-within-200-feet.} " t -; -�•- ;..r_ <br /> i <br /> Septic Tank: Distance from nearest well-.-:57_6------Distance from foundation__4e____--__Materia____________ _-1J <br /> No. of com artments_.-_.. .- �-�1� Liquid de th..._____ <br /> P �- -�- - ...Size- - -- �-��----- q P. �-- --- -- Capacity--- <br /> Disposal <br /> - <br /> Disposal Field: Distance from nearest well-Z-a......Distance from foundation__fQ_.__.____.Distance to nearest lot line----___._ <br /> mow' Number of lines,._.___---------------------Length of each line_/eDQ_/-------------.Width of french --- <br /> Type of filter materla4_� r_. . C � Depth of filter material---_ .._____..Total length..................;?,4q.D_._.......-.- <br /> 5eepa a Pit: Distance to nearest well_ ----Distance f om foundation--.l_-2-4_"-..Distance to nearesf lot line-5_.. <br /> Number of pets-__. ------------Lining material � . Size: Diameter.. _.._._......Depth.... 5------------------ <br /> Cesspool: Distance from nearest well ------------- --Distance from foundation-_ ------------- ..Lining material--------------------------_.__------- <br /> ❑ Size: Diameter- -- -- ------ - -- ----------------Depth--------------__------------ ---------------------Liquid Capacity---------------------------gals. <br /> Privy: Distance from nearest well------------- <br /> -------------------------- <br /> _------- <br /> Distance from nearest building-------.--------.__----------.----_--__. <br /> ❑ Distance to nearest lot line ............... --' <br />'E f <br /> f <br /> Remodeling and/or repairing (describe)_--------_____---------------- <br /> ----------------------------------------------- ----------------------•----------------------------------------- <br /> ------------ •-------------------------------------- ------------------•---------------------------------------- ---------------------•---------------------------------------------------------------------- ------ <br /> l <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, Sta�laws, and rules and r gulations of the an Joaquin Local Health District. <br /> (Signed)------------------ ------- - -- --- ---- - ........ ----------- ---- - -- ---(0 ner and/or Contractor) <br /> r F <br /> Ar^^ ­ . <br /> (Plot plan, showing size of lot, location of system in relation to we buildings, etc., can be paced on reverse side). <br /> I' <br /> FOR DEPARTMENT USE ONLY , <br /> APPLICATION ACCEPTEDBY__ �s-.-----------------------/� -------.--------. ___--2-,� <br /> p <br /> r� <br /> - DATE------------ <br /> REVIEWEDBY---------------------------------- ---- ------------------------------------ ----------- ------------------------- DATE <br /> BUILDING PERMIT ISSUED-------- -- - -- -------------------------------------- ----------------- --- ---------------------- DATE <br /> Alterations and/or recommendations------------------ -------• - - ----•--- • _.._.---------111-1----•------------------------------•----- -- J <br /> ------1111-- --------------------- --------------------------------- - - 11 -------------------------------------------------------------------------------- ---------I--------- - ------------------------------- <br /> --------- ; <br /> --------------- '--- <br /> -------------- ------------------------------ ----------'----------- --------------------------------- <br /> - - `- -- -1111-- -- <br /> ------ ----------------------1111....1111- -1111..--- -1111-- ----------- - ------------------ <br /> ----- <br /> FINAL INSPE TION BY:.. .__ Q,_.. _ - - -- --------1111-- Date------t - -`--- � <br /> --1111-- -- --1111-- - �--�-------1111-- , <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> f'• 1601 E.Ha:ellon Ave. 300 Wast Oak Slreef • 124 Sycamore Street 205 West 9th Street <br /> VVV Stockton,California Lodi,California Manteca,California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br />�. I <br />