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FOR OFFICE USE: <br /> 1-------------------------- -------------- ------------ - •. <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------ ----------------------..... (Complete in Duplicate) �'• <br />,.__.__........... .. .. ................ .__.__._..__ -__ This Permit Expires 1 Year From Date Issued <br /> Date Issued ._�A�U <br /> Application is hereby made to the San Joaquin Local Hsalth 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 /> r <br /> JOB ADDRESS LOCATION. --- ---------- a-``` , �`' "F <br /> .Owner's Name--------- -----•- ------------- _ ­----------- ------- - Phone-_.------------ ------------------- <br /> k Address----------------- -------- -- -------- -- -- - --------- -- - ------- -------------- - ----------------------------•---•------...- <br /> r <br /> Contractor's Name----- 6 - - ------ ------------------------------------ ------- -----------------------------------_------- Phone---------- •----------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mote ❑ Oth r ❑ <br /> Number of living units: _._ Number of bedrooms _-4__ Number of baths.3.... Lot size ______________________ <br /> Water Supply: Public system E] Community system A Private ❑ Depth to Water Table _...__ _ ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam IM Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes date................... ) 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.) O <br /> Septic ank: Distance from nearest wel{----JAP-1_Distance�ffrom foundation____. Material <br /> siz <br /> No. of compartments____ � � .-�_�___Liquid depth_.......... ........CapacityjSQ�_ <br /> Dispos Field: Distance from nearest well .E2_Q.�.Distance from foundation--- - _ -..-.- Distance to nearest I line��-----•-- <br /> Number of lines__.___,3_-_____ Length of each line_. a_x__b_�_ _.Width of trench-._ .____- <br /> �------------------- <br /> Type of filter materia4-_ ----------Depth of filter material.....j f' --------Total length__- ------------------------- <br /> Distance <br /> ---_--___.__--.`__._ <br /> Dlistance to nearest well-----�. 9D__ ---Distance from�foundation__-:-�®_____._.Distance�o nearest���e.__�_--__..._ � <br /> Number of pits--- ,X-------._._._.Lining material----41_----------- Size: ✓3rem�ter_�---/Y-��_._-.Depth---- -- ------------------------- <br /> Cesspool: Distance from nearest well ________________Distance from foundation................. ..Lining material-------------------------------------- <br /> h .- <br /> ❑ Size: Diameter- -- ---------- --- ---- - ---- ----Dept -------- .--- -------------------------- --- Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------)_--________..___.._._.--_-.------Distance from nearest building.----------------------------------------- <br /> ❑ Distance to nearest lot line -------- ------ ----------------------------------------------------- ------- --------------------------------- <br /> � I <br /> Remodelingand/or repairing (describe}--------------------------------------- ---------•----------------------------------------------- -------------------------- ---------------------- ... <br /> I ----------------- -------- --------- <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, laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed ----------- <br /> ------ -- ----- .......... .-------------- - ------ ------------------------- dor Contractor <br /> gY� -1------------ ------- -- ---- -- ----------- ------------------------------- -----(Title)---------- ------ -------- -------------...... ------- -------- <br /> (Plot plan, showing size of lol, location of system in lation to wells, buildings, etc., can be placed on re'versa side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED ----------------------------------------------------- DATE._/----1_-7.."'. <br /> -- --------------------------- <br /> REVIEWEDBY- ------------------- ----------------------------------------------------- DATE------------------------------------------- ----------- <br /> BUILDINGPERMIT ISSUED---------- -- ---------------------------------- ----------•-------------------- -- ---------- ----- DATE--------------------------- -- ---- - --- <br /> i Alterations and/or recommendations:_---_...._._-_._ <br /> ------ ---- ---------------_----=x. - <br /> 1 4 S <br /> �. <br /> ----------------- ------------------------------------- --------------------- ---------I--- ----- -------------------------------------------------------------------------- ---------- ---- ------:--------------------- <br /> ' 'I- -/Jlt�ilr. Date----1-.�--/--�`" <br /> FINAL INSPECTION BY:_ _ .� �..__...__. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ha:ellon 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 />