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FOKvrFICE USE: <br /> ------ -------:---- <br /> _ APPLICATION FOR. SANITATION PERMIT Permit No. . <br /> {Complete in Duplicate} <br /> Date Issued <br />--------------------------------------- <br /> This Permit Expires ] Year From Date Issued 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. po7 _Z5 p.-mar <br /> ,2_5357 3 - eo,�A f�;a -I- <br /> 4------ <br /> JOB ADDRESS AND LOC 1TIlO1N.� 4>------ ---- --��l �'-"r+°�'-'" '�- -------I---- ----¢-�1 ---_-- <br /> �i.�`- <br /> Owner's Name.____ ----------- Phone-------------- -- <br /> AddressPtd` rxT s --3-!P--•----------- ----- ------------------------ ----- -------•---------------------------------------•-••--------------- ..._... •.-_.. <br /> Contractor's Name-^6�0 -•--------------------------------------------------------------------------------------------•--- ---------------- Phone----••-----••---•--------•--------- { <br /> r <br /> Installation will serve: Residence [ ' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -------- Number of bedrooms -------- 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 ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date.---_--------------} No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <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_.07_0_-------Distance from foundation---4------- Material_____ ____________________---___._.-.____-___. <br /> No. of compartments-._.1------------------ � � <br /> ---Size__3_ ...1-0__ __s _ <br /> .---Liquid depth__ .:`..... --------Capacity-J-0-70-0_`1----- <br /> V) <br /> Disposal Field: Distance from nearest wefi. J.___._Distance from foundation---tb_--------.Distance to nearest lot line__S___-__-... <br /> ® dumber of lines-__ '---�---- g + <br /> Len th of each line.-----,llr Q_____________Width of trench.... "'. _­--.----------------- 11t <br /> Type of filter mater,ial_,_---�--_______ Depth of filter material------/1y------ otal length-_/_ -----_--__ <br /> -------------------------- <br /> I <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation___________________ Distance to nearest lot )ine----------------- <br /> juNumber of pits------ ---------------Lining material-----------------------Size: Diameter-----------------------Depth------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---------._-----------__._---_--___-. <br /> ❑ Size: Diameter------------------ -------------------Depth------------------------------ ---------------------Liquid Capacity-- -------------------------gals. <br /> Privy: D+stance from nearest well-------------------------------------------------Distance from nearest building._._____..----..-----____--_-._._.-_----. <br /> ❑ Distance to nearest lot line. _ -------------------------- -------------------------- ------------------------- --------- <br /> Remodeling and/or repairing (describe): . _ n.:c'�.-- _ '�.1 ?! « -------------------------------------------------- <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. <br /> -- ------------- <br /> (Signed)--- 2 --- - --, f -- _________-- (Owner and/or Contractor) <br /> bY ------------- - - ------------------------ � 7MT+le`)7—. .�.�.-_- _-- .... -`-_ .�.,. <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_ --------------------------------------- DATE-. � F <br /> REVIEWEDBY-------------=------------------------------- ------------ -------------------- --------------------------------------------. DATE-- •-------------------------------------------------------- <br /> BUILDING PERMIT ISSUED------------------------- ------------- - <br /> -----------------------------------------------------------• DATE <br /> Alterations and/or recommendafions:----------------------------------------------- ------------------------•-----------------------•-•------------•------------------------------------ ---- <br /> -------------------------------------------------•------------------------------------------ - - ------ ------------------------------------•-----------------------•-----------•--------------•------------------------ <br /> -------------------- ----------------------------•--------- --------------------------------------------------------------------- -------------------------------------------------- -------------------------------- <br /> ------------------------------ --------------------:-------------------------- --- ------ ---------------- ------------ -------------------------------------------------------------------------------------- <br /> FINAL INSPECTION2- ------------ - --- Date- _'�-d. G (, . <br /> I SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Maxelton Ava. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street <br /> Stockton,California Lodi,California .. Manteca,California Tracy,California <br />