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FOR OFFICE USE: <br /> ------------------------------------------------ <br /> .. ..............___----_..;_._..____-- APPLICATION FOR SANITATION PERMIT Permit No. <br /> --------- -------------------- -- ---------- --------- (Complete-in Duplicate) <br /> Date Issued <br /> - <br /> ---�------- -- • ----- --------------- ------ This Permit E <br /> � xpires 1 Year From 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 Ordinan No. 54 . <br /> JOB ADDRESS AND, LOCATION----------------- �� . •-----....-(Rl.,�'~ <br /> QQ ------- ------------------ ----------------------------------Phone_Ir'02-7-a -- <br /> I Owner's N me ----- -------- -h <br /> Address �� ------- -- ----------- ------ -- ---- ---------- <br /> Contractor's Name----- <br /> ------------ <br /> - ---••--- -- --------------•------------------ ------ Phone. <br /> Installation will serve: Residence ®.Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: _�_._ Number of bedrooms _ Number of baths__� - x �. <br /> - Lot size ----- . .�--- - •--- -- ---- <br /> -------------------- <br /> WaterSupply:�Public systerri ommuriity�system❑—Private4❑-'Depth'to W/fi_rTable Zc ft <br /> 3 Character of soil to a depth of 3 feet- Sandravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous A lication Made: If es,dote_-..____._..._ <br /> PP � Y ---.- ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> .(No_septicrtank-or:cesspool permitted-if pubiic-sewer--s available-withinr200-feet.)= <br /> Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material _.________.__._.___.___________..____....____. <br /> i_ ❑ No. of compartments Size ---------------- ---- ------Liquiddyepth.- - -- ------ --------Capacity--------------------- <br /> Disposal Field: Distance from nearest well-5 ------Distance from foundation__.. ��l_ ---------Distance to nearest lot line---15____..---- <br /> Number of lines -----_:--------Length of each line-_ ----� .._�.______-__Width of trench------- '7 <br /> Type of filter material "1 - ....Depth of filter material----AF---____..Total length----------6__d�.____________..____ <br /> Seepage Pit: Distance to nearest well.____..--------------Distance from foundation-------------------_Distance to nearest lot line__.___..______.. <br /> ❑ Number of pits.-- ----------.___._Lining material--------'s------_----- Size: Diameter-----------------------Depth---------------- <br /> Cesspool: Distance from nearest well _ -------------Distance from foundation_______ ________ __Lining material ...__----..__..____.________._--__ r <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 <br /> ---------------------Remodeling and/or repairin (describe}:------- ---------------------r� _------------------- ---- --- - 1 ,�..R, <br /> M. <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, State laws, and rules 'and regulations of the 5an Joaquin Local Health District. <br /> € (Signed). ------ -------------------------- ('waw emend/or Contractor) <br /> 1 <br /> BY: / ----- --- {Title) <br /> -�[Plo+-plan;showing ' e o ot;location- ^sys+em�in-relation -wells;buildings;etc.;"can-b plated on reverse side].—� " <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION',ACCEPTED BY E R - ......... --- ----------------------- -------------- DATE_-------q_� <br /> REVIEWEDBY.--- -------------- --------------- ----------------=---- - ------ - ---- ------------------------------- --•--- DATE----- <br /> ' - -- --------- ------------- ---------------- <br /> l BUILDING PERMIT ISSUED-------- --------------------------------------------- <br /> Alterations <br /> ------------------------------------------Alterations and/or recommendations:--------------- - ­­----------- ------ --- <br /> ---------- --------NSC_ -- -- ---------fiDP--------5----- 7-0. , - -�_N ..moo.-----!'t K So <br /> -------------------- ------- ----•------- ------------ --------------------------------------- ----- <br /> FINAL INSPECTIO _ __... Date.. ............ ._Z :. . <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> i 1601 E.Hazelton Aye. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> 1 <br /> Stockton,California Lodi. California Manteca,California Tracy,California <br /> k E.H.9 2M 1-67 Vanguard Press <br /> I <br />