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i'OR OFFICE USE: - <br /> _________________________________________________________ APPLICATION FOR SANITATION PERMIT Permit No. � � <br />` ------------- ------ ------------------------------------ (Complete in Duplicate) <br /> --------------------- This Permit Expires 1 Year From Date Issued 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 Ordinance No. 549. >3 >�0= <br /> JOB ADDRESS AND " <br /> Owner's Name__--.---_ t ,�l_ <br /> ----- ------ - --:.-- =----------------------- Phone--------------------------------- <br /> Address. C )` .---••---------- ---oa-----------------•----------------------------..------------------ <br /> Contractor's Name------------ �F w- f `' ` ' Phone <br /> Installation will serve: Residence Apartment House [] Commercial ❑ Trailer Court DN- Motel ❑ Other ❑ <br /> Number of living units: ___ --_- Number of`Eedrooms ---li-7 Number of baths..___f__ Lot size ----- � �__ ___________________ <br /> Water Supply: Public system ❑ Community system ❑ Private a Depth,to Water Table _4�!ft. <br /> N <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑l. Clay Loam,] Cray.E❑ Adobe ❑ Hardpan ❑ i <br /> Previous Application Made: (If yes,date----------- ------) No jU New Construction: Yes ❑ No FHA/VA; Yes ❑ No PE <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool p ii itted if public-sewer is available within 200 feet.)' ' <br /> E <br /> Septic Tank: Distance from nearest well_ _____________Di 1 ante from.founclati 'n 777777=ferlal_..___..--_________-.____-_-------______._.. . <br /> ❑ No. of compartments- -------------Size--------------------- [Liquid depth------ Capacity <br /> Disposal Field: Distance from nearest we!#_ D `._Distancexfram„foundafion /P- ..Distance.tto nearest lot line_-`:5 ____ <br /> Number of lines-i - 1 <br /> _ --R__ _-.__-_Length of each line�� � _.Width of <br /> Type of filter`matehal___ sj�p� Depth of filter material__.f�_!�_6__.Total length_-_.jt�D_--- <br /> � <br /> Seepage Pit: Distance to nearest'wefl-------1____-------Distance from foundation_________Ae-�___+Distance to nearest lot line____..,__-_.._ <br /> ❑Q Number of pits_ !------------------jLining material---------- --..._.:.---Size: Diameter.--------(�_----------[Depth__.---------------•- <br /> ------------ <br /> 11 <br /> Cesspool: Distance from nearest -- <br /> ----- ------Distance from foundation_______ ____ Lining material__.__-------------------------- I <br /> ❑ Size: (Diameter---------------------1------------.Depth_----- -----------= LiquiCJ Capacity gals."--.,i <br /> Privy: Distance from nearest well___ _________________ , <br /> ______ .__Distance from nearels# building------------------------ <br /> ._-__-.._-_..____. <br /> �. , , ­ <br /> 171❑ Distance to nearest lot line.-on, ------------------------------------------ ------ ------ J-)--''--- <br /> - -- ------------------------------------ <br /> Remodeling and/or repairing describe:------_ -- -_ <br /> ;t - <br /> -----------------------•------------------------------------- ---------------••---------- ----------------•---•--------------------------------------------------D--- ----=----------------------------------------------- <br /> f I <br /> t <br /> ___----------------------------------------------____:-_--______-________-_._____ ..___----_-_----------------------- <br /> ___-_---___________ --___-_--____----_-„-_____-__________- -------------------------- <br /> I hereby certify that I have prepared this application hat the work will be done in accordance with San Joaquin County <br /> ordinances, Stat d rules and. regulations o he an Joaquin Local Health District. <br /> (Signed)----------------- ----�€� `� ---- ---- — i�4 ` € �(Or /or Contractors <br /> BY:--------------------- ----- ------------------------------------------ t----t(Title) <br /> (Plot plan, showing size of lot, location system in relation to wells, buildings, etc., can be placed on reverse Ade). <br /> t <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_ - ) TF ��� 6� <br /> - ------ DA .-- �� ' <br /> REVIEWEDBY------------------------------------------- - -------------------- ------------- ---------------------------- ------- ------ DATE------- <br /> BUILDINGPERMIT ISSUED--------------------------------------------------------------—--------------------.------------ ----- DATA------------------------- <br /> Alterations'And/or recommendations:-�_ <br /> -•-----------------------•------------------I---------------------------- -------------------•----•------------------------------------------------------•------------------------------- ------ <br /> ---------- ----------------------------------------------------------- --- -------------------------------------------------------------------------•--------------------------------------------•------ ------------------ <br /> ---------------- -------------- --------- - <br /> FINAL INSPECTION BY:---------- Dates <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 Lodi,California Manteca,California Tracy,California <br /> 1 <br />