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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT Permit No. 1.5._6. 0.. <br />- <br /> ----- <br /> --------------------------------------------------- <br />--------------------------------------------------------- (Complete in Date Issued �___ / .Duplicate) d f._/_5_ <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 LOCATION -1-•••�---- ---------------"��-- ' [ = iL[�(?`------------- ..................-...... <br /> Owner's Name------- ------ • --. ------------ ---.-. Phone........................ <br /> Address---��4. )....... -=------ f ----f.' <br /> =- ' <br /> Contractor's Name---------- ---- ------------------ �`------- ------------------------- -----��---•-•----••-----------•----- Phone................................... <br /> Installation will serve: Residence Apartment HouseCommercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: I------- Number of bedrooms -_I___-_ Number of baths --t---- Lot size ..... P--p'_------------------ <br /> Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table ........ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel Sandy Loam ❑ Clay Loam ❑ Clay ff Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date____________________) N New Construction: Y7V 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_ . � __IDistanc fro foundation----/;�. -------Matpr�al_----_---__ ► ��i.� a <br /> No. of compartments_----_.__.,�_____._---.Size._��C_�=�__�_Liquid depth______�__�__.__�.__._.Capacity__�L>.C��__._ <br /> Disposal Field: Distance from nearest well_/_-'� Distance from foundation... --------Distance to nearest lot line-.:_-----•___-___- <br /> Number of lines-_____ -----------------------_ ength of each line f'<: --_�-c�'_ i`d fi of trench___! ____.__..._________ <br /> \ Type of filter material._.$__-1 �pth of filter material__../_8_...--------Total length---lfs ______________________ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line_____-__-__--__-_ <br /> ❑ Number of pits______________________Lining material-----------------------Size: Diameter------------------.----Depth__-.---__._______-__•--___.__-___ <br /> Cesspool: Distance from nearest well---------------••Distance from foundation--------------------Lining material__-.__--.-------.----____-_--__---_-_. WWW <br /> ❑ Size: Diameter-------------------------------------Depth----•---------------•--•----------------------------Liquid Capacity_-------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building__----.-_-.--_--___-___------._-_.--__-._. <br /> ❑ Distance to nearest lot line--------- -,11F-------------�Li---------•---------••---------------------- .---•---------------- <br /> Remodeling and/or repairin (de tribe): -- =-- -------------- ----- ��'� ------ C`-------- <br /> ---- .� -- ..; �0 <br /> �t g7- ' ---�- ---t-- ------ ----------- --------------------------------------- <br /> --------------- <br /> ---------- - <br /> c -•- Sl.l__..._..---------- ---- .-- _tel? �•;. � <br /> I hereby certify that I have prepared this application and that the work will be done accordance with San Joaquin County <br /> ordinance$, State laws, and rules and regulations of the San Joaquin Local Health Distric . <br /> (Signedf�- _ _________________________ -----------------------------------------------------------------(Owner and/or Contractor) <br /> By:--_-------- -•-•---•--------•---• ------------------------------------------------------------------------------------(Title)--------------------------------------------- -- ---- --------- <br /> (Plot plan, showing size of lot, loc. ton 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 /> BUILDINGPERMIT ISSUED-------------------------------------------------------------- -------- DATE--------------------------------------- ; <br /> Alterations a / rre menda ' ns----------- ---- ----- - ----------------- -•--- .••---- <br /> C�-f-��1 ------'E-�---- ---- - 11 <br /> ----------------- �1� J <br /> e�-=J�,� �. . <br /> '"�` <br /> 'f <br /> FINAL INSPECTION BY:. _� r � = /_!-- ------------ Date----------- 1f= - // <br /> / = <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 /> ES 9 REVISED S-59 3M 3-'63 F.P.CD. .._ <br />