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FOR OFFICE USE: <br /> 00 <br /> ------------------------------------ --------- <br /> APPLIC TION FOR SANITATION PERMIT Permit No. ._. ` .� ...I <br /> (Complete in Duplicate) Date Issued <br /> Z 3 <br /> _______________________________________________ This Permit Expires 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 Ordinance ^^No. 5499 <br /> JOB ADDRESS AND OCATI N--••L �--•---............. L_�___. ---------------------------- <br /> Owner's Name..._.,' <br /> ,,(( / J Phone <br /> Address -•------- ........................ �`' I�a----- -------------------------------•--------- --•-------••------•----------•---------•------------•-------•---•--•--------- <br /> Contractor's Name --•---•----------------------•---------- Phone.................................... <br /> will serve: Residence W Apartment House ❑ Commercial ❑ Trailer Courtotel ❑ QTer F]Number of living units: ---I.... Number of bedrooms ._umber of baths ...I---- Lot size -_-_-. _ .__ ...... ------------------------- <br /> Water <br /> -- _________________Water Supply: Public system ❑ Community system K Private ❑ Depth to Water Table .-M ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Q Clay U� Adobe ❑ Hardpan <br /> Previous Application Made: (If yes,date-----------_--------) No� New Construction: Yes Z�l 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 /> Se f* Tank: Distance from nearest well_/NOQ.i.Distan p fro �ound��n__A_�______.Ma eral___ __ _____________ __ __ _-- '..----- <br /> PR of compartments__.?j._....____._._Size.�._�_�_.._x__.___Liquid depth__�C'__4',--------Capacity../,A,0Q.__. � <br /> Disposal Field: Distance from nearest well10 0®.'/Distance from foundation.... Distance to nearest lot Il e.S <br /> Number of line -____________ ___ --____ _Length of each lin;O_=_6'-�°�:_ U.Width of trench___7' <br /> Type of filter material_�1- __C_De th of filter material__.�---------------Total length------ <br /> Seepage Pit: Distance to nearest well______________________Distance from foundation....................Distance to nearest lot line----------------- <br /> El 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 /> 11 .___-.❑ Distance to nearest lot line--------- --------------•--•------------•-----------------------------------------------------------------•----------------------------------- <br /> Remodeling and/or repairing (describe):------ ------------ --------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------ r <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- `'1J <br /> ---------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------ <br /> I hereby certify that 1 4iiirviii prepared this a plication and that the work will be done in accordance with San Joaquin County <br /> ordinances, State law�arand r nof the $an Joaquin Local Health District. <br /> E� <br /> (Signed - --- - -----------------------------------------------------(Owner and/or Contractor) <br /> By:----------------------------------------------------------------------------- ------------------------------------- -----(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 /> APPLICATIONAC�jEPT�,yY--------------------------------------- ----------------- ----------------- ------------------ DATE------------------------------------------------------- <br /> REVIEWED BY--------Ke!-.��..!�------------------ ATE---- / -_'............... <br /> BUILDING PERMIT ISSUED — 6 DATE--- ` <br /> Alterations and/or recommendations---------------------- ------------------------------------------------------------------------------------------------------------------••-------•.....------ <br /> ------------------------------------------- ---------------------------------------------- --------------------------------------------------- --------------------------------------- -----------------------•-•------•••- <br /> ---------------------------------------------------------- ----------------- ------------•------------------------------------------------------------•-------------------------------------------- ------•-•---------••-- <br /> --------------------------------------- - ---- ----- ---------------------------..---- <br /> -------------------------------- --­­-------------------­--•-- ------ ---- ---------------- ------------------------------------------------------ ---------------------------------------------------------- <br /> FINAL INSPECTION BY:.--- -------------------------- - -- <br />