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FOR OFFICE USE: <br /> ----------------- ----------- -------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit Nb. : - �__� � <br /> .. __ ------ (Complete-in Duplicate) <br /> Date Issued <br /> _._ -.- ._ .___.._. - ------------- --------- This Permit Expires i Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein-,described. . <br /> This application is made in complian,,Gf with County Ordinance No. 549. <br /> t <br /> JOB ADDRESS ;i_ <br /> &CATI0;N&"_ -�-,.�------------------- <br /> --------------- I��/1.---------- <br /> r ,/I ���JJJ//////JJJ <br /> Owner's Name.- Q Ph ne_.-- --------------- ---------- ----------�----------------- --- ---------------------- <br /> Address-------------- --- r �------ --- _--f---- ---- <br /> Contractor's Name---- ------------- T 0------- ---- - Phone /Lti. ¢.� <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __ �_._ Number of bedrooms L... Number f baths �_._ Lot size _-4-t4-4._ __ ___ __ _______.___-.--__..____._._.__ <br /> Water Supply: Public system E] Community system ❑ Private [ Depth to Water Table ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam [!r Clay Loam ❑ Clay ❑ Adobe ❑ 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 /> SepticTank: Distance from nearest well ..!T`Q._`..._Distance from ffoundation____._/_Q_`'____.Material ......Q.__.__. <br /> No. of compartments-------P1—............. Liquid depth____._..... ........Capacity_.4ple-g_. <br /> e <br /> Dispos Field: Distance from nearest well..$O.......Distance from foundation---ZO...........Distance to nearest lot lina_sr-.. ..._.. <br /> Number of lines._.._________I---..____- _ Length of each line_. ___ ©_`______________Width of trench_--_.�--_-___---.-_--_--_ . <br /> Type of filter material_-____._S_ _.- -._Depth of filter material------l _.----._Totallength-------r7a___I_____________________ <br /> Seepage Pit: Distance to nearest well..................-.-Distance from foundation--------------..___.Distance to nearest lot line_---_ _.__ <br /> ❑ Number of pits--- ------------------Lining material-------- Size: Diameter-----------------------Depth----...-------------------------- <br /> Cesspool: Distance from nearest well _______________Distance from foundation.__.------------- -.Lining material--._.-._.__._-_-.-._-_.-_________- ; <br /> ❑ Size: Diameter- -- -------------- ------- ........Depth.- -------------------------------------------------Liquid .Capacity. .-------------------------gals. <br /> Privy- Distance from nearest well------------ -----------------------..........---Distance from nearest building_...__-_...._.______.________..___.._.___- <br /> ❑ Distance to nearest lot line ---------------------- -- - ------------------ ------------------------------ --------------------------------------- <br /> �,/J n <br /> Remodeling and/or repairing [describe):__.._. -.-._ -u- __ I <br /> --•--•-------•--------------------------------------•-------------------------- ------------------------------------------------------------------------------------ -- ------------ ------------------------------ \ <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, S laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)------- --- ------ ---- - ....--- --------------- ------------------------------------- and/or Contractor} <br /> By:- - - --------------- ------------------------------------------- <br /> (Title} -..... <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------------------------------------------------------- DATE..... -7 <br /> REVIEWED BY----------------------------- ------------------------------------------------------------ <br /> ------------------_---------- -------------------- ---------------------------------------------- DATE------------------------------ <br /> -------------------------- - <br /> BUILDINGPERMIT ISSUED-------- -- -------------------------...----------------------------------------------------------.-- DATE------------------------------------ --------- ------------- <br /> Alterations and/or recommendations:---................ ------- - ---------------- -------------------------------•- --- ------------------------------ ---------------------- <br /> ----------------------------------- ---------------------------- ------- - ------•--------------------------------------•-------------------------------------------------------- ---------------------------------- -------- <br /> FINAL INSPECTION BY01 ------------------ Date 1-.- +. <br /> -- --------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br /> t <br />