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FOR OFFICE USE: <br /> ..4 ` _ - APPLICATION FOR SANITATION PERMIT Permit No. <br /> ..__....._ f _ (Complete 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 County Ordinanc No. 549. <br /> JOB ADDRESS AN OCION'3( _�1�->Lci`-- ..._..._.Oti-Es-QcI n� � - `'4'I ''_'`�,(� --------•• .... <br /> Owner's Name..... :. C. ..-.....-... _. .-. -..-...__ Phone...... . <br /> Address...... ..... . .. . ..... ......... J ......... .-- -- --...-..._....... ...---------....._............. ........-..................... <br /> Contractor's Name....... LL ............................. Phone------------ --- .............. <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Treiler Court ❑ Motel ❑ Other �af/ ' <br /> Number of living units: ". Number of bedrooms Number f baths ..�. Lot size ........ --�� '`�'-- ..... <br /> Wafer Supply: Public system E] Community system ❑ Private [eDepth to Water Table ........ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Ed/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 /> Sept ank: Distance from nearest well Distance fro foundation....../..0._......Mat tial.. rtw..... <br /> _..... <br /> p , i <br /> No. of compartments.. _ `� .-_- _Size.3.._X _LAS.Liquid depth_....... <br /> Dispos Field: Distance from nearest well...A?.......Distance from foundation...../..P. <br /> . ...... to nearest lot Iine.S...... -V. <br /> Number of lines__ .. ...Length o' each line.........'5r . ........Width of trench----Y......................... <br /> Type of filter material----------- ...----!_.-_Depth of filter material....-l.J'-_.- ---.-Total length...... ....................../.... <br /> Distance to nearest well. .../_00. '. Distance from foundation_._ .... Dis-,ance to nearest lot line...S..___.- <br /> ❑ Number of pits_ . `.- ---- ..Lining material......SZRj-...Size: Diemeiero+�..�. �n!Depth......I.A-................. � <br /> Cesspool: Distance from nearest well............. ---Distance from foundation--- ... --...... Lining material......... ............. <br /> ❑ Size: Diameter. .. ...............................Depth _. _-. - ---- - --------- .-Liquid Capacity............................gals. � <br /> Privy: Distance from nearost well................................... .......... _Distance from nearest building..................._.................... <br /> IJDistance to nearest !at line...... ......................................__......................................_-----•---••--•----_.................................. <br /> Remodelingand/or repeir;ng (describe:.. _.. .. ..... ....... . .............•---•----....._...................................------...._.----------_..._...__......... <br /> .......... . ..._ • . <br /> ................ -- <br /> ....--- -----••-----.................. . .. <br /> ..............................................._ .............._..........._---- ....._...........�..•-----. ... ..........- -- 1 <br /> .................................. .. .............................................................................................................................................................................. <br /> I hereby certify that I have prepared this application and +hat the work will be done in accordance with San Joaquin County <br /> ordinances, Sta"s, and rules and reg7ionof the San Joaquin Local Health District. <br /> (Signed) ------- ------ _ -- rand/or Contractor) <br /> By:...... . r1- ----------`-------- ... .. .. ....................... - -(Title). _ <br /> (Plot plan, showing size of lot, location of systerri in relatio to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.... --• •.............................. ..... ........ .................... <br /> REVIEWEDBY.........................................................................................--.............-.................... DATE.......................................... ......_......... <br /> BUILDINGPERMIT ISSUED..........................._.............................._._.........._...._................... DATE..............._...................I........................ <br /> Alterationsand/or recommendations:........_... .... ............................_................................................._...--........._........................................ <br /> ................_...................................... . ............................................................-.W..............................................._..._......,.................................. <br /> ................................................ -..-. .----- -- ......................................_..r............................................--.------------------ --------- <br /> FINAL INSPECTION BY:.....��:cyrza �J`._._ . ...... . Date.-_---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stoddon,California Lodi,California Manteca,California Tracy,California <br />