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FO OFFICE USE: <br /> (Il�7-7---------- "--------! -- --- <br /> ......-"............................I—.... ___�.- APPLICATION FOR SANITATION PERMIT Permit No. -----a`----- <br /> -----------------------------v....- .---- -- (Complefe•in Duplicate) Date Issued <br /> ___ _____-----... ._-___....__.... This Permit Expires 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 Count Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION...- _ -. �----- --------------------- - - - <br /> - <br /> Owner's ------------------------------------ --- --- -------------------------------- ...... Phone------------------------------------ <br /> Address------------- ---------------------------.--------------- <br /> Contractor's Name------ Z ------• -----•-------------------------- ----- -- -------------------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence O­�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: Number of bedrooms _3__ Number of baths -1----- Lot size __Y.S?..t1._!.!_ _---.___--_--.--_._---__.__..- <br /> Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Tabled ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sa y Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: (If yes,date------------------- ) No New Construction: Yes ❑ No ET-_ FHA/VA: Yes 0 No ®T. <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ` <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septi Tak' Distance from nearest well___ Distance frFm foundation_w---f----------Mat rfal ---_ <br /> n No. of compartments---__- ��►► <br /> Sizev-3 �C "�[ �7 Liquid depth Capacity--- <br /> IL ©c9 5 <br /> Disposal Field: Distance from nearest well--------- __Distance from foundation_/U..............Distance to nearest lot line_._6___-_-. <br /> E3'--qWof Number of lines __.---__--Length of each line__ ----------Width offrench...t2_4-_`--------..-_____-_- �y <br /> f <br /> Type of filter material__.._1...¢�. __.Depth of filter material-:_� _��___.______Total length...... __Q________________ _____--- <br /> i <br /> Seepage Pit: Distance to nearest well___ .............Distance from foundation-_/A--------__..Distance to nearest lot line-C.5--1__.__-_-_ <br /> [�r_ Number of pits.-. .1�_-------Lining material_��!� Jr_... Size: Diameter_-.33.4 ----- ----Depth---- `.f--------------- <br /> Cesspool: Distance from nearest well ----------------Distance from foundation................. ..Lining material-...--_-____----___._____._-_---_--. <br /> ❑ Size: Diameter- -- -------------- ----------------Depth- ------ -- --------- ----------------------Liquid Capacity--------------------- -gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------------- ---_- <br /> ❑ Distance to nearest lot line ------ ------------------------ - ------------- <br /> Remodeling <br /> - -------Remodelin and/or repairing (describe): --------- - - Q � - <br /> �io-W_�� _-e-�_. . M------- _1 - ------------ <br /> - •-----------•---------------------- •------------------------ ---- <br /> ----------------------------------- ------------------------------------------------•----••••------------------------------------------------------------------------------ ----------------------------------------- - <br /> I hereby certify that I have prepared this application and t at the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and r s � lations t San J reguquin Local Health District. <br /> (Signed)-------------------- '-- -------_-----(Owner and/or Contractor) <br /> By:---------------------------- •----- ----------------------------------------------------------------------- ------ (Title)---------- ------ -------------- -- -- -- - <br /> (Plot plan, showing size of lot, location of system in relafion to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY / y <br /> APPLICATION ACCEPTED BY -�-rJ /Le/1 ------------------- ----- DATE-----`f. r �1.. -----------------------. <br /> REVIEWEDBY------------------------------------------ -- ---- -------- -------------------- ------------------------------------ -----• DATE---------------- <br /> ------------------ <br /> BUILDINGPERMIT ISSUED-------- -- ------------------- -- --- ----- ------------ --------------------------------- DATE._------------------------------ <br /> Aifer4rtions a d or recommendations-------- --------- --...-- --- ------_----------- ------------------------ --- --------------------------------------- <br /> 7..... _ -- -------------- --------------------------------- ----- ------------ <br /> ---`--------------------------- --- -- - ----------------"---------------------------------------------------------•---------- ----"---------------- ----------- ------- I--- ---------------------------- <br /> J <br /> FINAL INSPECTION BY:-.- ._ � ✓ , .� Date---- <br /> ------/ -----f-2--.--`- - - /> <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stoeklon,California Lodi. California Manteca,California Tracy,California <br /> E.K.9 2M 1-67 Vanguard Press <br />