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712 OFFICE USE: <br /> ------------1— �--- -- ------ ------�-r <br /> ---------- -------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. J-24.. ..... <br /> ------ -------------------------------- -------------------- .: 4Complefe,in�'Duplicafe), +• � 3�/ <br /> ------------------------------- - ------------ Date Issued •----�f / <br /> This Permit Ex fres 1 Year From 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 <br /> J08 ADDRESS <br /> LOCA ION v ��p,j"-- Z�(D �((� <br /> --------------- ------------------------------------- - <br /> Owner's Name ------ Phone--- <br /> Address-----••------ ---- <br /> ----------- ------ -------- -----•-------------------------------••----------------------------------------------••-- <br /> Contractor s Name_______________ _ <br /> Installation will serve}: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: -- Number of bedrooms —?-- Number of baths -A.-- Lot size _---.- <br /> ------------------------ <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table .40 ft. <br /> Character of sail to a depth of 3 feet: Sand-0 Gravel ❑ Sandy Loam ❑ Clay. Loam ❑ Clay ❑ Adobe ardpan ❑ <br /> Previous Application Made: (If yes date_________________._) No �ew Construction: Yes ❑ No R9�FHA/VA: Yes ❑ No ®— <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permit#ed.ff public sewer is available within-200 feet.) <br /> Septic-Tanki Distance from nearest well-----------------Distance from foundation__^_.______ ______-Material__________________________________________ <br /> ----.. <br /> �� �•� No. of compartments-.-. __.`-------------------Size--------------------------------Liquid depth---- ----------- Capaci#Y :-r <br /> -----•--------v <br /> Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line______________,_ <br /> Number of lines -----------.----Length of each line------------------------------Width of trench /. <br /> Type of filter material-------------------------- of filter material-----------------------Total length----------- <br /> ----------------- <br /> ___________I <br /> Seepage Pit: Distance to-nearest well-_____ __ /_ L <br /> _h:__Distance from f undation__ _.Dista�r?ce to nearest lot line_o i <br /> Number of pits------l-----------__Lining material0--------- Diameter_-- -._--------Depth,`� '� � ' <br /> Cesspool: Distance from nearest well_________________Distance from foundation-----.--------------Lining materia!__.___-_________. <br /> ❑ Size: Diameter------------ --------------------Depth------- - <br /> -------------------- ------------- -------Liquid Capacity--- ----------------------•-gals. CIF <br /> Privy: Distance from nearest well_______________'--------------------------------Distance from nearest building-------------------------------------------- <br /> ❑ Distance to nearest lot line--------------------------- <br /> Remodeling and/or and/or repairing (describe):-------------- G ✓ r <br /> ------------------------------------------- .1 <br /> --------------•----------------------•------------------------------------------------------------------------ --------------------------------------------------•------------------------------------ <br /> -------------------------------------------------------------------------------------- <br /> 0 i <br /> ­­ <br /> ----------------------------------------- ----------•------------- --•----=-------------- ------------------------------------------------ ------------------------------------------------------- ------------ <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. t <br /> (Si ned <br /> 9 )--------•------ -- ---------- <br /> - ----- (�or Contractor) <br /> By:---------------------------------------•-------------------- - Title <br /> - - ------------------ ----- -( ) 1' �� ------ ------ - - <br /> of plan, showing size of lot, location of system r ation to wells, buildings, a+c., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----- --------------------- ------------- _:._����------------------------------------- DATE--- I ° <br /> REVIEWEDBY------------------------------------- ------ ------- -------------- ---... DATE- <br /> -- -------------------- <br /> BUILDING PERMIT 155UED----------- -------------------- ------------------- ----------------- ---------------------- -- D/ATE----- ------ <br /> ---•------ <br /> Alterations and/or recommendations:_______________------------_____-_..__.____._.._.___.--____: <br /> • <br /> - -----------•-------•--------•--------- <br /> ------------------------ ---------------------------•--------------------------------------------- t� <br /> _-----------------...-------------------------------------------------_..-------------_ - .FINAL INSPECTION BY------- ------- ------- ---------- ------------- Date---- --- �.. .-. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazellon Ave. 300 West Oak Streets 124 Sycamore Street 205 West 9th Street 1 <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> rCB 9 REVISED B-59 3M 3-'63 F.P.Cq. <br />