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FOR OFFICE USE: r <br /> 4 <br />...._ -------------'------------------ <br /> - <br />--- ------------------------------ -------- ------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. c _f. <br /> ---------------------- ---------------.- ------ - (Complete-in Duplicate) <br /> ------------------ ' This Permit Expires 1 Year From Date Issued Date Issued <br /> 11 <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 complia e`with County Ordinance No. 549. �- <br /> JOB ADDRESS AN, L CATION_ _f�__ -_ ___ ----- -------- -.-- <br /> --- - ------ ,.p -,-------..�, <br /> Owner's Name-- --- - - ---- - <br /> P <br /> Address----------•---------- / r -------- - ----------------------­ <br /> - --------- _- - <br /> 1 �>_ _ <br /> -------._. Phone--- .-------- <br /> Contractor's Name---- • -•-- -- --•---` --r�- -'--�--�- �----'���----------- --------------- --•-- •---- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ • <br /> Number of living units: _- .l_ Number of bedrooms _a2=Number f baths�-.--- Lot size ____-. `si.c,e��er, ----------------------- <br /> Water Supply: Public sysfem C1 Community system [] Private Depth to Water Table ------ _ ft I <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------------------- l 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 /> Septicank: Distance from nearest well___'rV./_---Dista`n'ce from founda n__A?-�...____.Material - ..._________. <br /> No. of compartments --- T � 'r - iquid depth --. Capacity 1� <br /> Size -----.Ca acit _1 e <br /> Dispo I Field: Distance from nearest well--., �..r.._Distance from foundation---___62-- Distance to nearest lot line, <br /> Number of;lines._'t_____}-- ----------------------Length of each line__ __......__.-_----_--.Width of trench-_..�__-.________-.._----__-_--- <br /> Type of filter material-__-__-_ ....- .Depth of filter material_ .. ._._Total length------f._a-Q---**_-.___-_._____-_.__ <br /> Seep ge Pit: Distance to nearest well.....l..044 -------Distance from foundation----1p_ __._-.Distance to nearest lot iine_�......_._ <br /> Number of pits--- ------- material____/Zt-_._. Size: Diameter____, _-------Depth--- _________________ <br /> Cesspool: Distance from nearest well ................Distance from foundation----------------- -.Lining material------------------------------------- <br /> r_1 Size: Diameter ----------- ----- - -------Depth-----:---------- ----- --------------------------Liquid Capacity---------------------------9a1s:. <br /> ----------- <br /> L. r` --_ __Distance from nearest buildin <br /> Privy: Distance from nearest well--------------- ----- k 1.. g --- <br /> ❑ Distance to nearest lot line ------------- ------------ ------------ ------------------------------------------------------- ----------- <br /> Remodeling <br /> -----Remodeling and/or repairing (describe):------ -- - ------------ ------------- ---------------------------- ----------------------------- ------- ----------------------------------------------- . <br /> s i <br /> - 1 . <br /> -- -- ---- ------------------------- -------------------------------------------------------•------------------------------------------------------------------------------------------------------------------------- <br /> I hereby cep1s, <br /> l have prepared this application and that the work will be done in accordance with San Joaquin Court <br /> ordinances, Statd-rules and�regula ' of the San Joaquin Local Health District. <br /> Si ned _ /or Contractor)( g )------------- -- / - <br /> By----------- 3,r!__------ -- ------------ _.:-------------)Title)--------- - ----- _------ <br /> (Plot plan, showing size of lot, location of sys+em in relati to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY �7 <br /> APPLICATION ACCEPTED BYE--- ------ - ----- ----------------------- ------ - ----- DATE-- ------------------ ---------- <br /> REVIEWEDBY------------ i- =------ ._---------- --------------------------------------- -------------------- ---- DATE---------------------------------- - <br /> BUILDINGPERMIT ISSUED-------- ------ ------------------------------- ---- ---------------------------------------------- DATE-------'------------------------------------------------- -- <br /> Alterations and/or recommendations:-------------- -.- -------------•----- --- --------------------------------------------------------- ----- --------------------- <br /> --------------------- --------------------------- ---------------------------------- ---------- -----------------•-------------------------- ------ ---------------------------------------------------------•-•- ----- <br /> ------------- -------- ------------------ ----------------------------------------- --------------------------------------------------------- -- . .. <br /> FINAL INSPECTION BY:.. I ------------------ Dete.o_-.--- U --- ........................ �. <br /> ! SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lach. California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />