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pi <br /> FOR OFFICE USE: �' , <br /> - <br /> --------------------------------- ----------------- <br /> --------------------_--_--.-.-._...-- -__-.- APPLI ATION FOR SANITATION PERMIT Permit No. .............` .— <br /> ------------------ -------------------- ------- (Complete-in Duplicate) <br /> Date Issued <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. 549. <br /> JOB ADDRESS AND LOC TION_... ,__�------ <br /> Owner's Name - - hone <br /> --- ---••----•------------------------ <br /> Addressa rl� �� - <br /> Contractor's Name--s�:.- - <br /> , ----------------------------------- --- -- <br /> Installation <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: I___ Number of bedrooms _/___ Number of baths.-J---- Lot size .__�Q._-�X_/CI-I�._--____________________ <br /> Water Supply: Public system ❑ Community system a Private ❑ Depth to Water Table 1D- ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy LoamM Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date------------------- ) No ❑ New Construction: Yew 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---/0---------Material 1�G_ _ <br /> No. of compartments___._._` Size___ y _/�XrS___Liquid depth___/____._ ....... Capacity_.,016 <br /> Disposal Field: Distance from nearest well-; rDistance from foundatiof_ LQ__ ------Distance to nearest lot line-- <br /> _ _ <br /> Number of lines______ ___....____. ___-Length of each lin <br /> a3csr- Width of trench <br /> Type of filter materi al:_% � ----Depth of filter material - -'ii---------Total length-----�1�-—----------•----------- \, <br /> Seepage Pit: Distance to nearest well-----_----------.__-__Distance from foundation--------------------Distance to nearest lot line----------------- <br /> 0 Number of pits.-.------------------Lining material------------- -------- Size: Diameter_______________________Dept h_______.___-______._________ p <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) --- ------------------------------------------------------ -------_- ............................. (iV <br /> --------•----------------------------------------------- ----------------------- -------------------------------------------------------- <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 San Joaquin Local Health District. <br /> (Signed) -•/Cres------------------------•------------------ -------------(Owner and/or Contractor) <br /> BY: - ---- -- - - ----------------------- ----- ----------------(Title)---------- -------------.. <br /> (Plot plan, showing size of lot, locati of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> F9R DEPARTMENT USE ONLY / p <br /> APPLICATION ACCEPTED ---- 2Q---- --- -------------------------- ---- ---------- --- ---------- DATE----moi �� Q <br /> REVIEWEDBY------------------- ---------- --------------- -------------------------------------- --._.. DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSU -------------------------- ----------------------------- -------------------- ----------------- DATE------ --------------------------- <br /> Alterations and/or recommendations:----------------------------------------- <br /> --- ------------- --------------------- ----------------------------------------------------------•--------------------- <br /> ------------------------- ------ -------------------------------------------------------------------------------------------------------------------------- <br /> --------------- <br /> FINAL INSPECTIONB ------------------------------------- Date----- --(/ ` 7 .(Q ¢ --------------------------------------- <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 /> E.H.9 2M 1.67 Vanguard Press <br />