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FOR OFFICE USE: <br /> ----- <br /> Permit No. - - � --•-• ` <br /> " ---"-- --- -- .....""" - ------------ ---- APPL,ICA710N-�FOR-SANITATION PERMIT ,�yy-•• ----- ' <br /> - -------------------------------- <br /> (Complefe-in Duplicate) Date Issued <br /> This Permit Expires 1 Year From Date Issued to i <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. 00-6--- 2Ze ~47 <br /> .. ' ---- ------------------------ <br /> JOB ADDRESS AND LOCATION. ---, __/ > ----- - <br /> /w= --------------------------------- ---- Phone------------------------------------ <br /> Owner's Name_. <br /> ----------- <br /> Address----•---: ------�------ - <br /> --------------------------- <br /> 1 Phone-----------------------••---------- <br /> Contractar's Name_�w- � - -""-"--' -""""""" "--� " <br /> Installation will serve: Residence B Apartment F-iouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _ .--__ Number of bedrooms __3--- Number of baths i.-__._ Lot size __.__ 't -�- <br /> Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table 8a - it <br /> Character of soil to a depth of 3 feet Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Z Clay ❑ Adobe ❑ Hardpan- ] <br /> tion: Yes E] No El FHA/VA: Yes No E]Previous Application Made: (If yes,date_------------------ 1 No [I New Construc ❑ a - <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: J <br /> (No septic tank or cesspool permitted if,public sewer-is-available w.ithin_200 feet.)- --- <br /> Septic Tank: Distance from nearest well.................Distance from foundation---_.___._.------_.Material ------------- -------------------------- <br /> El <br /> Liquid depth"-- ----- ------- --------Capacity <br /> ! No. of compartments-- ------ _­---- ----Size-------------=---- ----------- --•----------------- - l <br /> Disp sal Field: Distance from nearest welly--------.-Distance from foundation---j-Q_�__.-----Distance to nearest lot line_ _______"..___- <br /> Len Length of each line__ _f jo "- -- ----- - Width of french--- ��---------------------- <br /> 1 Number of lines__---_____ {,�--- - g DD <br /> Type of filter laterial !-.-/Pj-----------Depth of filter material..-_�7-------------Total length._.__ ------.---------------- <br /> A-Pi <br /> Seepage Pit: Distance to nearest well_._-_--______________Distance from foundation--------------------Distance to nearest lot ine_.._.___...----. <br /> ❑ Number of pits---------------------Lining material-----"------- -------- Size: Diameter_:-------------------Depth----- --- ----------------------- <br /> I <br /> � Cesspool: Distance from nearest well _-_"_____..__-"-Distance from foundation_-______________ _,Lining material__._.--."---------------"--""-gals-. <br /> ❑ Size: Diameter ----- ------ -------Depth------------------ -- ------ - - -------------- .Liquid Capacity <br /> Privy: Distance from nearest well..... ..........---------------- <br /> Distance from nearest building------- ------------------------ -------- <br /> f <br /> ❑ Distance to nearest lot line -------- --------- ------------------------------------------------ ---- -- ------ <br /> i' <br /> Remodeling and/or repairing (des�ribe�;. �ti <br /> I -------------------- - ---------------------- <br /> ---------------------------------------------- <br /> 1 -------------------------------------------- <br /> -------------"-----------------------------------------------------•--------------------------------------f--------------------- --------- <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 Heaith District. <br /> ' <br /> ............ <br /> (Owner and/or Contract <br /> ------ ---- - - - ----------------------------------•--- ----------------------- <br /> Si ned <br /> ----------------- <br /> ► -..��s_By:----�-------------------------------- •• <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> l FOR DEPARTMENT USE ONLY <br /> .. . <br /> APPLICATION ACCEPTED BY-- - --- ---- ---- �------- -------------------------------------------------- DATE_!jP_`•-fi'�.--�--6.T-- -------- ------- ------- <br /> 1 - DATE REVIEWED BY------------------------------------------ -- ---- ------ - <br /> BUILDING PERMIT ISSUED-------- - _-.___. --- <br /> ------ - DATE------------------------- ---------------------------------- � <br /> Alterations and/or recommendati#ns-------------- - ------- ----------- ---------- ------------------------------- --------------- ----------------------- ---- ---------- <br /> ------- ---------- ---------- - ------- - <br /> -------------- •-- ---------- <br /> ----- ; <br /> ----------- <br /> ------------- ----------- --------- -- <br /> f ---- ----------- - ------ ----------------- -------------------- ------------ ----- <br /> FINAL INSPECTION BY: ------- -- <br /> Date........ �. .----------- ------------- ---------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ha:eiion Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street <br /> 4Lodi. California �A Manteca,California Tracy,California <br /> Stockton,California - <br /> I <br /> E,H.9 2M 1.67 VangUord Press <br />