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FOR OFFICE USE: <br /> --------- � .. -Permit No. ...1.. ..1 ( <br /> 3,m APPLICATION FOR SANITATION PERMIT <br /> ----------------- ------------------------ 6 <br /> ------------------------- (Complete in Duplicate} 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 LOCATION___ <br /> _------------ <br /> Owner's Name------. f / -t?- .- --- -- Phone--f-'77=/�"s" <br /> Address-------------- ----------- <br /> Contractor's Name__-- � —^ -------------------------------------------- Phone <br /> Installation will serve: Residence U]-`*Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> / f <br /> Number of living units: __I____ Number of bedrooms ---2 Number of baths _�___ Lot size ___._ Ca- ---�'oQ--•------------------------ <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 [2--clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: [if yes,date....................l No ❑ New Construction: Yes ❑ 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--------------------Material_-------------------------.__-___.._- ---------- <br /> F-1 <br /> -____❑ No. of compartments------------ -------------Size-------------------------------Liquid depth--------------------------Capacity--•-------------------- <br /> Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line._______-_._____ <br /> 4 ❑ Number of lines-------------------- - -----------Length of each lire------------------------------Width of trench-------- --------------------- <br /> Type of filter material--------- of filter material-------------------- <br /> length------------------------------------------ <br /> Distance fr foundation__ ---.Distance to nearest lot line_ ----------- <br /> ge <br /> Seep❑ait: Dis#ante to nearest well_.______"-�___ f <br /> Number of pits----.-.-f------- --- <br /> Lining material_S /�BP�fC-.Size: Diameter--.._��_�r-----Depth__.��------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------.__.___-._____-._El . <br /> Size: Diameter----- ---- ------------------- ------Depth------------------------------------------ --------Liquid Capacity---------------------------gals. <br /> Privy: Distance from nearest well----------- ~.---------------------------------Distance from nearest building-----------------------------------------. <br />! ❑ Distance to nearest lot line---- --- ------------------------------------------------- <br /> ribe]:----; ---- - <br /> ---- � <br /> -- 11Q� ----------• <br /> Remodeling and/or repairing (desc <br /> t <br /> t ------------------------- ----------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------I--------------------------------------------------------------------------------------------­­----- V <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�attd rules and regulations of the San Joaquin Local Health District. <br /> (Signed) <br /> / .- .. 1` _--_._ /fl. ------------------------------------- ----------- -(Owne • and/or Contractor) <br /> =a.,t � ___ATitle}p.------ <br /> B .. ---------- - r - <br /> (Plot plan, showing size of lot, location system in relation to wells, buildings, etc., can be laced on reverse side}. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- ---------_ ) v " <br /> ,�� --- DATE. <br /> REVIEWEDBY----------------------------------------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED------------------------- ---- ---------- ------------------- -------- ----- ----------- DATE--------------------------------- --------------------- <br /> Alterations and/or recommendations:-- ----f�,3�G-S- �J: Ur ------------------------------------------------------------------------------- <br /> ------------------------------------ -------------- --------------------------- ---------------------------------------------- <br /> ----------- ---------------- -- --- <br /> FINAL INSPECTION BY:---,,�11. .. ------------ ------------------------- Date.- -- ------- ------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> i Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.CC- <br />