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FOR OFFICE USE: <br /> .......................... ----------------------- <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—3,OD — 0-3 <br /> f 6 26oIr <br /> JOB ADD ESS AND CATION________ _._._ .-.---_._.Z .l - ---._..�_ ------------------------------------------ <br /> '04 It <br /> Owner's Name-_- ^--ti--------- ,/ ------ ------ Phone---------------------------------- <br /> Address------_-- <br /> -------------------•-••----------Address------_-- �'J ....... - -` �� ' - -..---- <br /> -------------------- ------ ----------- <br /> Contractor's Name--- ---- .- ------ - ----- ---- -- ------- ----- --------------------------------- Phone <br /> Installation will se : Residence Apartment House ❑ Commercial F] Trailer Court ❑ Motel ❑ //Othenrr Ej <br /> Number of living units: ... Number of bedrooms _ _ Number of baths /.._ Lot size ----ear' -_rl _moi__-� __ <br /> Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table .----- - ft <br /> Character of soil to a depth of 3 feet- Sand R Gravel ❑ _Sandy 1"oam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date_.-------- .---.--- 1 No x 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 /> Septic Tank: Distance from nearest well_..%�......Distance from foundation-ZO----------Material ._ <br /> No.. of compartments-_.__:�?71---_-_.__... _Size--- Sx_- -��---Lquid depth..._�'--`----- --------Capaccty_�� <br /> _,qDF'_ <br /> Disposal Field: Distance <br /> from <br /> lines nearest well Gr.__---Distance <br /> is ath of from <br /> line--.ation-A_ --- Distance to nearest lot line--%g <br /> r <br /> v� _ __.Width of trench_.�__r._l�._ __C <br /> rpt - g <br /> --- <br /> Type of filter material__ Depth of filter material--� �'_-_---Total length` - ��e) <br /> Yp -- -- --- ------- ---- <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 /> Remodeling and/or repairing (describe):------- ------------ ------ --- -------------------------------------------------- ------------- -------------•-------- <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)------------------------------------------ ----- --------------------------------r------------------------ (Owner and/or Contractor) ; <br /> By:----f- - ---- 4--- 4�_ L -C-----------------(Title)----- - - ------- . ----------- ......... <br /> (Piot plan, showing size of of, location o sf ystem rtFi station to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED 8Y- -. .... ------ DATE- ---- ------ <br /> REVIEWED BY--------------------------------------------- ------------------------------- ------------ --------------------- - ---• DATE-------- -------- --------------------------- <br /> -------------- <br /> BUILDING PERMIT ISSUED----- -- -- ------ DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:-------- --------------------------------------------------- ------------•------------- <br /> ------------ ------------ -----------------------------------­--------- -------------------------- ----------------------- ----------- --------------- - •--- ----------------- ------------------------------------- <br /> --- -------------------- ------------- ------ -------------------------------------------------------------------------------------------------------------------------- --- -------------------­.-- <br /> -------------- ---------------------------- <br /> FINAL INSPECTION BY: --- ---------------------- Date....... `. �� -------------•--------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazellon 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 w ,, <br /> J <br />