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FOR OFFICE USE: gjobb <br /> -- ---- ------- ------ ------------ l {per <br /> _______________________-___________-__----___ APPLICATION FOR SANITATION PERMIT Permit No. �� �.... <br /> ------------------------------------------------------- (Complete in Duplicate) <br /> __________._______ - I This Permit Expires 1 Year From Date Issued Date Issued 19-- -2.45� <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 ADDRES D LOCfSII,ON <br /> Owner's Nam ?`1'-- `----- G----"�--- <br /> --------------------------- ---- ----------- ----- - Phone------------------------ <br /> �.. . -­---------------�= ----•----............................... <br /> agntractor's Name-- ------ -- Phone................................... <br /> will serve: Residence Apartment House ❑ Commercial Trailer Court ❑ Motel Other ❑ <br /> Number of living units: ___- Number of bedrooms _F}- Number of baths ---�-- Lot size ----576------.. Y- /b-•U <br /> 16 ----------- <br /> Water Supply: Public system ❑ Community system 4 Private ❑ Depth to Water Table _1©-_ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe❑ Hardpan ❑ <br /> y r Previous Application Made: (if yes,date---------____.____) N6,IA' New Construction: Yes ❑ No FHA/VA: Yes ❑ No ] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: / \ <br /> r <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tan : Distance from nearest well-_Distance from foundation_--------------------Material----------------------------------------- ------No. of compartments--------------------------Size--------------------------- ---Liquid depth--------------------------Capacity---------------.------ <br /> is sal Fiel : Distance from neares well____._--_____Distance from o_unffi�_tion__-_l��-----Distance to nearest lot line's�_.___� <br /> Number of lines.__. -____________________Length c e� lirfe'_ "___._...__.Width of trench--- -------- <br /> Type of filter material Depth of filter material____.l__ __._Total length---------- _-____--_.__•______-__ <br />.... <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):------------------------ '2-J---—----------------------------------_.-------------------------------------------------- <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 /> s <br /> (Signed)-----'- %?iG c-- - - - --. -_ ____.(Owner and/or Contractor <br /> ) <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 /> APPLICATIONACCEPTED BY------------------------- ----------------------------- ---------------------------------------- DATE--------------------------------------------- <br /> REVIEWEDBY ----------------------------------------- --------------- DATE------------------------------------------------------------ <br /> BUILDING PERMIT ISSUED-----------------------------------------------------------------------------j-'_- 1-6A. . <br /> Alterations and/or recommendations------------ -- --------------------------------------------------- - <br /> ' ---------------------- ----- --------------- <br /> --------------------------•-•-------------------------------------------------------------------------------------------------- <br /> -------------------------------------------------------- ----------- ----------------------- --------------- ---------------- --------- ---------------------------------------------------------------------------- <br /> FINAL INSPECTION BY:---- = - Date ----- <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 />