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FOROFFICE USE: <br /> - ---- ---------- ------------------- p <br /> APPLICATION FOR SANITATION PERMIT Permit No. .. I__ <br /> ---------------------- ------- ------------- -- (Complete in Duplicate) <br /> Date Issued <br /> --------__ _ <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. 417-C)9- <br /> JOB ADDRESS AND fLOCATIOlN_I _l� `/� e1a�'� ...... t"fS _42�___ tt - f� ....... <br /> 5 --- F <br /> Owners Name_ L` l-' _ //�" _- Phone._ <br /> - ---------------------------- ---------- ------------------------ F_----- ' �3 -2- <br /> Address _ ......1 .0 . /4Wl>........ .%. 'I R_ �' �} !4RCx� �--------- f <br /> Contractor's Name---- ----- ' - ..£.Z--------------------------------------------------------------------------- Phone-_rS .t _:'6. - ! <br /> Installation will serve: Residence ApartmentHouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ___L._ Number of bedrooms _2-- Number of baths ___k Lot size -1-5_loo&._ <br /> Water Supply. Public system ❑ Community system ❑ Private ® Depth to Water Table .. __ ft. <br /> Character of soil to a depth of 3 feet: Sand [ Grave! ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: Ilf yes,date--------------------l No ew 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 /> k)(ij;jt-)^d No. of compartments --------- -----------Size--------------------------------Liquid depth.----------------------.--Capacity------------------ ---- V_ <br /> Disposal Field: Distance from nearest well-----------------Distance from foundation---.----------------Distance to nearest lot line------__-____-. <br /> E'ClJE�1­f a6 Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- s <br /> Type of filter material-------------------------Depth of filter material----.--------.---------Total length-__-___._---------__..__--------- --.--- <br /> Seepage Pit: Distance to nearest well_____6__V_.----Distance from fo nciation----/_0_--._.Distance to nearest lot ine_ ------ <br /> - <br /> Number of its__ -1__. .__Lining material---- ._ .Size: Diameter.p__ ------Dept ------------------------ 14 <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):__' e� ��----- ,—a rte-- - - - --------------------------------------- <br /> - ----------- --------------------------- r----------------------------------------------------- <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 /> (Signed)--6F,.- ------- ------------ <br /> f /f Owner and/or Contractor <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 /> APPLICATION ACCEPTED BY- ---- ---------------------------------------------------------------------- DATE-------Z 2--- A,7-'---------- <br /> REVIEWEDBY------------------------------------ ----------------------------------------------------- ------------------ DATE <br /> BUILDING PERMIT ISSUED----------------------------------- ----------------------------------------------------------------- DATE---------------------------- � <br /> Alterations and/or recommendations:----------•- --------------------------•----------------------------------------------------------------------------------------------------------- <br /> ----------/---------- <br /> FINAL INSPECTI BY: �'�•r --- - ._ Date- ----- - E �. - ------ <br /> --------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hasellon Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.F.0 O. - = i <br />