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FOR OFFICE USE: <br />---------------------- = ------------------ <br />APPLICATION FOR SANITATION PERMIT Permit No_! ..... 62� <br />4 ------------------ --(Complete in Duplicate)3 —� <br />��l --------------------- This Permit Expires 1 Year From Date Issued - Dote 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.Cu9t — Or iqance Np. 549. <br />20 ta, <br />LOCATION <br />- - ---------- _�� ..... ------------------------------- <br />JOB ADDRESS AND - ---------------------- J'��IZ <br />Owner's Name ----------------- - ---------------- <br />Phone_.A_�_V`­�7il y/_ <br />1� <br />-------------------- -------­------- I_— ------------------------------------------ --------- <br />-------------- ....... _9 -------- <br />Address ------------------------- J <br />Contractor's Name---------------'---------- ....... .......... ------------ Phone....-----.............----------- <br />Installation will serve: Residence M Apartment House [I Commercial El Trailer Court 11 Motel 11 Other El <br />Number of living units: ___/--- Number of bedrooms Number of baths _1____. Lot size ------------ -/- .:� — -5 ....... x --- ---------- <br />Wafer Supply: Public syst6rn JZ Community system 0 Private E] Depth to Wafer Table <br />Character of soil to a depth of 3 feet: Sand [] Gravel ❑ Sandy Loom [I Clay Loam C] Clay ❑ Adobetq' Hardpan ❑ <br />Previous Application Made: (if yes, date_____________________) No E] New Construction: Yes 0 No E] FHA/VA: Yes E] No <br />TYPE OF INSTALLATION AND SPECIFICATIONS; <br />(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br />Distance from foundation ----- 10,11" <br />Septic Tank: Distance from nearest well__�-�� --- ------- Material --------------------------------- <br />No. of compartments ---------- ----------- Size ----- clepth ------------ V ------ ----- Capacity ------- <�b, 0 ------- <br />Disposal Field: Distance from nearest w4el(_ 0 D, <br />-------- Disfa,nt6'4�' m foundafidn,e ---------------- ista-ricefo nearest lot line ..... 45 ....... <br />-1 trench---_------- . . ......... <br />ts Number of lines_______________ -------- Lengf h of each line__________ <br />- ---------- 61-0 ---- -------- Width of frenc -------- <br />Type of filter material____- WAl _6epth of filter material -----__.%1___--.- Total length________ --------------- <br />Seepage Pit: Distance to nearest'well ---------------------- Distan-te from foundation ------------- .......Distance to nearest lot line._._..-..-_.:_- <br />El Number of pits---------------------- Lining material ----------------------.Size: Diameter----------------------- Depth--------------------..-.--------_ <br />fl <br />Cesspool- Distance,frorn nearest well___________- Distance from foundation --------------------Lining material.-------_______-_-________________ __. tth <br />Size: Diameter_________________ ___ - --Depth ---- '`�^: ------------------------------------------ Liquid Capacity ---------------------------- gals. <br />vl <br />J. <br />Privy:: Distance from nearest well -------------------------------------- k� ---------- Distance from nearest building_________________________________________ <br />0 Distance to nearest lot line-------------------------------------------\----•--------------•-•._....._..---------------- ------- ---------------­----------- I -------- --- <br />Remodeling and/or repairing (describe): ---------------------------------------------- <br />----------- -------------------------------------- ­­­ <br />_.__. ------------ ----------- ------------------- <br />------------------------------------------------------------------------- ------------- = -------- I ... ------------------------------------------------------------------------------------------------------- <br />I---------------------- ­ ....... 11 ---------------------- <br />-- -------------------------------------------------------------------------------------------------------------------------- 7 ----- ------------------------------ <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 />(Signed)------------------------ ----------- ----------------------------------------- -Owner and/or Contractor <br />- <br />• <br />By: ---------------------- --------------------------------------- ---------------------------------------------------------------------- (Title) ------------------------------- ----------- ---------------- <br />(Plot plan, showing size of 16t, location of system in relation to wells, buildings, etc., can, be placed on reverse side). <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY- - --- - - --------- -- I ---- ---------------------------------------- DATE------- ---------------------- --- <br />REVIEWED BY--- /_,� - ------ ------------------------------- --------------------------------- DATE ------------------- -1 --------- --------------- I ------- <br />--------------------------------- -- ------------ <br />BUILDINGPERMIT ISSUED-------------------- ----------------- ---------------- - -------------------------------------- DATE ------------------------------------------------------------- <br />Alterations and/or recommendations:--_[ s. --- ------- --------- ---- f t <br />- ------ <br />--------------------------­ ------------------------------------------------ ------------------------- --------- I—— ------------------------------------------------------------------------------------------------------- <br />---------------------- ----- ------------------------------------------------------------------------------ ------------------------------- --------------------------------------------------------------------------- <br />----------------------------------------- -------------------------------------------- ------ I ------------------------------------------------------------------------------- ---------------------------------------- <br />----------------------------------------------------------------------- I ------------------------ ------ ----------- ------------------------------------------------------------------- -------------------- <br />FINAL INSPECTION ------- --------- ---- Date ---45 - -- — ----- (oA ---------- --------------------------------- <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Streit <br />Stockton, California Lodi, California Manteca, California Tracy, California <br />