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�. .� <br /> APPLICATION FOR SANITATION PERMIT Permit No. .f �il� <br /> ---------- ---------------------- ------ (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 LOCATION----- <br /> ------------ . , .___-___..-_"fit . <br /> ------------------------------------------------------------------------------------------ <br /> Owner's Name-------- f'� }- -•- •----•-------------------- ------------ Phone__��� ----- <br /> Address----------------------------------�T� `t s�_ - --_------------------------- <br /> Contractor's Name-------------------al:kl[l ,P_./1 ---------------------------------------------------------------------------------- ------------ Phone----------------------------------- <br /> Insfallafio:h will serve: Residence :� Apartment House E] Commercial ❑ Trailer Court E] Motel [:] Other E]Nurriber of living units: ---I---- Number of bedrooms'.. Number of baths __. __ Lot size ----- <br /> ---------- <br /> Water Supply: Public system Community system ❑ Private El Depth to Water Table L9-'ft,I' <br /> Character of soil to a depth of 3 feet: Sand E] Gravel,[] Sand Loam ❑ Clay Loam ❑ Clay ❑ Adobe lardpan ❑ <br /> Previous Application Made: [If yes,date----- ------------) Nom New Construction: Ye No ❑ FHA/VA: Yes ❑ No [EL—­ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet. <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------Material---.------------ --_-.--__--_-._ <br /> tffi5�77! No. of compiLrtments---------- _*------------Size--------------------------------Liquid depth--------------.-.---------Capacity----------------------- <br /> Disposal Field: Distance from nearest well___________Distance from foundation_-_.-�j-/------Distance to nearest lot)ine----J-_r <br /> a7• F�, Number of lines----------------- Length of each line___------air--__......Width of trench--_---.1___,_..___.._ <br /> t" g -- --------- <br /> Type of -Filter material-, <br /> aterial_ fi'�._ *Ok Depth of filter material__-__-f�=� __-Totallength-----------��_'------------------- W <br /> Seepage Pit: Distance to nearestwell------------------Distance from foundation_----ro--------Dista ce to nearest lot life--J_'...... S <br /> BAS Number of pits---.----.------------Lining material--Aa -----Size: i:er_-1_rr_C4Z_-_......Depth----.--�----------------------- <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 and/or repairing (describe)------------------------------------------- -_-_ - -------------------------- <br /> -------------------------- � "� '``� -----•---------------- <br /> -------------------- <br /> -------------------------------- ------------------------------------------------------------•------------q--------------------------------------------- --------------------------------------------------------- <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, StLla:ss, and rules and re alations f the San Joaquin Local Health District. <br /> (Signed,)----- ---,--4----- t <br /> - ------------------------------- --. (Owner and/or Contractor) <br /> By:- -----•-----------•--------------•----------•---------------------------- --------------------------------------------------------(Title------------------- ---------- --------- -......----- ----- - <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------------e-`_ DATE_. .' •-1.7-- _ <br /> ---------------------------- <br /> -----------------REVIEWE <br /> D BY ----- ------------------- ------ --------------------------------------------- DATE <br /> BUILDING PERMIT ISSUEDDATE <br /> Alter do s and/or recommendations.. -------- .---• - - ----- <br /> ----------------------------------- ----- --- ------- -------------------------------- -----------------------•- ------------------------------------- <br /> ----------�-- -. -----7---- -------------------------- ------------------------------- <br /> ---------- - - <br /> FINAL INSPECTION BY:. I< <br /> - -------------------------- ------------ Date_---------------- <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 Man} / <br /> eco,California Tracy,California <br /> F.P.CO. <br />