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F OFFICE USE: <br /> �y SANITATION PERMIT Permit No. -- <br /> -- -- ------------------- ---------- APPLICATION FOR <br /> - <br /> -------------------------------------------------- <br /> (Complete in Duplicate] �1 ` ; <br /> t Date Issued .__._ __l�______ <br /> -___-----___-----_-_._- This Permit Expires 1-Year From Date Issued <br /> ------------------- <br /> t y 17v r <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work here <br /> This application is made in compliant with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION -------- ----- // ` <br /> � __ <br /> .& <br /> ,Owner's Name-.--� Phone-----------------------•------.----- <br /> -------------------------------- :-----------------•-- ----------------------------- <br /> Address <br /> Contractor's Name____________________________ <br /> ----- Phone. <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer ❑ Motel [I Other Z <br /> Number of living units: ------- Number of bedrooms -------- Number of baths�____.._ Lot size ____---___ -------------•------------------- <br /> Water Supply: Public system El Community system El Private Depth to Water Table/o_ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam ❑ Clay Loam [I Clay ❑ Adobe ET--`H n ❑ <br /> Previous Application Made:,: {1f yes,date--.-----------------) No [j--lNew Construction: Yes S—No ❑ FHA/VA: Yes ❑ No <br /> v1 <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 weal__-___.__Distance from foundatlon__�4__._.____-Material__ .-____________________________________ <br /> 1 ®� No. of compartments__-_oZ_______________Size3?-C_SX�___--__-__Liquid depth-------��-------------Capacity____ _ `" <br /> 4Disposal .Field: Distance from Weare twell- -----_--__(Distance from foundation_.l4-_f_.__--.Distance to nearest lot line___-__-_ __r <br /> ❑� Number of lines---- ---------- Length of each line---�--`------------------Width of trench------ --------I----------- <br /> Type or filter material-- f` Depth of filter material_-,,-/_8.........Total length--------------------9----------------- <br /> fl <br /> i Seepage Pit: Distance to nearest well----- ----------------Distance from foundation--------------------Distance to nearest Sot line----------------- <br /> +: ❑ Number of pits----------------------Lining material-----------------------Size: Diameter.-.----------------....Depth-------------------_------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining materia}__._..______--_________--_________. <br /> ❑ Size: Diameter-------------------------- -----------Depth_---------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-..--------------------------------------- <br /> ❑ e to nearest lot line------ ------------------- - -------------------- ------------------------------ ------------------------- ------------- <br /> r <br /> Remodeling and/or repair ng (describe ��---- ------- ----------------- <br /> ----' --- ---- --------------------------------------------------------------------------------------------------------------------------------------------------- C <br /> --- <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 ,r <br /> ordinances, State laws, and rules and r ulaftons of the San Joaquin Local Health Disfrict. <br /> <----------------------------- _._.{Owner and/or Contractor <br /> I <br /> [Signed} A <br /> _ By:------------------- Title <br /> I (Plot plan, showing size of lot, location of system in rel to wells, buildings, etc., can be placed oq reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> `l lI <br /> APPLICATION ACCEPTED $Y--- -' •7-!L��------ - --------------- - -------------------------- DATE------ ------------------- - <br /> REVIEWED BY ---------- �� - DATE6$ <br /> k , <br /> BUILDINGPERMIT ISSUED---------------------------------------- ----------------------- ----- ------------------------- DATE---------------------- *�--------- <br /> Alterationsand/or recommendations-------------------------------------- --- ------•---------------------------------------------•------•------------•----------------------------• -----------­ <br /> ­ ---------------------------------------------- - ---------------- ------------------------ -------------------------------------------------------------------------------- <br /> -----------------•---- --------------------------- --•--- -------- ----------------------------- <br /> ------------ ---- - - ----------------------- ------------------------ ---------- --------- ----------------------- --------------------------- ------- <br /> E FINAL INSPECTION BY------)5.-=--- ------- Date--a---r---- ...... ---- - ----- - ------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1801 E.Ha:eltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> r.p.co. <br />