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FOR OFFICE USE: <br /> -------------------------------------- <br /> -------------------- APPLICATION FOR SANITATION PERMIT Permit No., <br /> ----------- - ----------------------------- -------------- (Complete in Duplicate) Date Issued <br /> ------------ --------------- --- ---------- ------------- <br /> I This Permit Expires 1 Year From Date Issued <br /> Amade to the San Joaquin Loca <br /> lication is hereby l Health District for a permit to construct and 'install the work herein described. <br /> pp -3 <br /> This application is made in compliance with,County Ord I inance No. 549, e)�_3— �06V —3 <br /> •,f770 A- <br /> JOB ADDRESS ANP, LOCATION17K,,". ---4�_�-- --------------- ------ <br /> u4'X Phone-----------------------•-------•---- <br /> Owner's Name- ----- —----------------•----------- ------- I ------------ <br /> Address--------- <br /> -s , - G)1t--k-- ---- --------------------------- ------------- <br /> Addres -------- ........ Phone----------------------------------- <br /> -- ---------(�?,- - ----- --------------------------- <br /> Contractor's Name-- - --- <br /> Residence [Apartment House 171 Commercial E] Trailer Court [I Motel El Other El <br /> Installation will serve: <br /> Number of living units: j---- Number of bedrooms ., --,Number.of bath ,-,Lot size ------- ------------------------ <br /> ? <br /> Wafer Supply:` Publit"system,0- -Community,system JI- -Private J� Depth to Water Table ft. <br /> Gravel n Sandy Loam E!r I Clay Loam El Clay E) Adobe[] Hardpan [I <br /> Character of soil to a depth of 3 feet: Sand [I <br /> Previous Application Made: (If yes date--------- --------- I No 0 New Construction: Yes El No El FHA/VA: Yes 7 No [I <br /> TYPE OF fNST;k1L_ATI?DN,AND SPECIFICATIONS: <br /> (No septic tank or cetsp.2.ol.perrinitfecl if public sewer is available within 200 feet.) 'T <br /> __Material------- ----------------------------------------- <br /> st well------------------ Distance frorn foundation-------------- <br /> Septic Tank: Distance from near'e . I id depth-------------------------Capacity..--------------------- <br /> F-1 No. of compartments----------- -- _-Size-:------------------------------Liclu x t . <br /> "' I ion----- .__.___.Distance to nearest lot line----------------- 7Q <br /> Dispos Field: Distance fr6m nearest well.....--------Distance from founclat ------ ---- <br /> -of linei -----/------------- <br /> Number ----------Length of each line------- ._.Width of ---------- <br /> -1--v ------f...O-A---------------------------- xtr <br /> ----- -------------Total length <br /> Type of filter material_____.. ___.t---- ---Depth of filter materia <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation Distance to nearest lot line_____.________._. <br /> -- ------- ------- ------ -------------------------- <br /> ❑ <br /> Number of --------------r----Lining maferial------ ------ ---------Size: Diameter Depth <br /> Cesspool: D ista nce'f rom'nearest well-------------- --Distance from foundation_----------------Lining material--------- --------------------------- <br /> ----------------------------gals. <br /> ❑ Size: Diameter;_._..____._ -------------------Dept h-------------- -------------------- - -------------Liquid Capacity <br /> Privy: Distance from nearest well----------------------------------------------- -Distance from nearest build.inq-------7------------------------------ <br /> Distance to nearest lot line-- _ -----------------------------------------------------------------­----------------------------------------- ----------- <br /> ❑ <br /> : ------ -'a_ f <br /> -A------_- ------------------- - -- <br /> ------ <br /> ----------------------------------- <br /> - <br /> Remodeling and/or repairing (describe) : _ ------------- --------------------- <br /> -------------- , . <br /> -­------------- -------------------------- ------------ <br /> I ----------------------- <br /> ----------------------------------------------- ------------------------------------------------------------------- . <br /> -------------- ------------------------------------------------------ I ---------- ----------- -------- ------ <br /> ---------:-------------- - ---------- -------------------------------------------------------------------------------------------------------------------------- -------------------- f j f <br /> I hereby certify that I have reacedthis application and that the work will be done in accordance with San Joaquin n Coun y <br /> s of the San Joaquin Local Health District. <br /> ordinances, State laws, and rules and regulation <br /> or Contractor) <br /> (Sign <br /> By:------ ---------------------------------------------------(Title)--------------------------------------- - - ...an <br /> .... ....... <br /> and/ <br /> ed)- ------- <br /> ca etc., can be placed on reverse side). <br /> (Plot plan, showing size of lot, location system relation to wells, buildings <br /> FOR DEPARTMENT USE ONLY <br /> J ----- ----------------------------- <br /> APPLICATION ACCEPTED BY-- - ------------------- ---------------------------------------- <br /> DATE_ � <br /> REVIEWED BY----------------------- ----------- ------ ---------------------------------------- ---------------------------------- --- <br /> DATE-------- ----------------------- ---------------------------- <br /> BUILDING PERMIT ISSUED------------------------------ ------------------------------------- <br /> -------------------• DATE-------------- ------------------ ------------------------ <br /> Alterations <br /> ----------------------------- -------------------- <br /> Alterations and/or recommendations:----------------------------- ------- -----------------------------------------------...... <br /> ------------------------------- ------------------------ ------------------------ ---------------------------------------------------------- -------------------------------------------------------------------------------- <br /> ----------­------------ ------ --­------------------------ --------------------------------------- ----I---------- ----------- ------ ----------------------- ------------------ --------- ------------------------ <br /> ---------I-------- ---I-------- ---------------------- ------------------------------------------------- --------------- ---------- --------------- ------- -------------------------------------------­­---------- <br /> ------------- -------I------------------------- -------------------- -------- --------- -------------- -------------------------------------------- --------------------------------------------------------- --------- <br /> Date �f ---------------- <br /> -------------------------------- <br /> FINAL INSPECTION --------------- ----------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. S 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />