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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------------------------------------- -- --- ------- - (Complete in Duplicate) <br /> ............. This Permit Expires 1 Year From Date Issued Date issued ___ _- ___ � <br /> a <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 ADDR S AND CATION-_ -- -i' - .-L -Fes---4.----- --- - ` 7 <br /> Owner's Name = � r..c Phone ------------------- <br /> --------------------- <br /> --. <br /> Address- = <br /> Ile- <br /> ---------------------------- <br /> --- <br /> *.. <br /> Contractor's Name � ` ' g------------------------ Phone----------------------------------- <br /> ------------ <br /> will serve: Residence O/Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: �---- Number of bedroom--- Number of baths._/---_ Lot size -------------------------- <br /> Water Supply: Public system [-] Community system ❑ Private [.Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam El Clay Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date-_-----------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No E] <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 /> [!] No. of compartments--------------------------Size-----------------•-----------------Liquid depth---------- ---------------Capacity---------------- ------ <br /> Disposal geld: Dis+ante from nearestwell__- ._.__Distance from foundation__ ?__.0._._.-_.Distance to nearest lot line__.r---_._____ <br /> Number of lines___-_---_-_/-.-.-_---_ _ Length of each line--------!a- _�.�-----.-Width of french__.._;��--------------------------- y' <br /> Type of filter material____.------V-- 9 <br /> t-_.-Depth'of,filter material----/_ .- _-----..Total length-----4P------------------------------ <br /> el <br /> Seepa Pit: Distance to nearest well_-_._/0C)___.-__Distance from foundation ---_-.___ Distance to nearest lot line---.-_.-- <br /> Number of pits._--_.--/--.-.-_---.Lining maferial__,,V1?..._._._...Size: Diameter------7.2._._.-----Depth__..�k. ______________._. <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--_................Lining material-------------__--._-.--__---___----. <br /> [� Size: Diameter--------------------------- ----------Depth---------_------- Liquid ' gals, � <br /> Privy: Distance from nearest well----------------------------------------------_-Distance from nearest building------------------------------------------- <br /> 0 Distance #o nearest lot line---------_-------------------------------------- - f <br /> Remodeling and/or repairing (describe):--------_-- <br /> -----------__ <br /> d <br /> a <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 regul"Offan Joaquin Local Health District.(Signed)----------------- ------- -------------------- ------------------------------------------------------------ °_ , remand/or Contractor) <br /> By------------- - � -------------- ` ------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc can be placed on reverse side). <br /> i FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED �--BY- f ------------------------------------------------ DATE---- 1 - <br /> +----------- ---------------- <br /> - =�•�—cam'-' <br /> REVIEWEDBY--------------------------------------------------------------------- ------- --------------------------------------------- DATE----------------------------------------•---------------- <br /> BUILDINGPERMIT ISSUED-------------------------------------------------------- ----------- -------------------------------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:-----------------------------------------------------------------------------------•----------- ---------------------------- -------•------------- <br /> ---------------------------------------- ------------------------------------------ ------ ------------------------------------------------------------- ---------------------------------------------------- <br /> --------- -----------------------------------_----------------------------------.-----------------------------------------------------------.-•------------------------------------------ ----------------------•--- <br /> ------------- ---------- ------- ---------­----------- ---------------------------------•---------- -------------------------------------------------------------------------------------------------- <br /> FINAL INSPECTION BY:,-.O--- --------------- ------------------------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.CO. <br />