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FOR OFFICE USE. <br /> = ----------- ----------- a sz� <br /> APPLICATION FOR SANITATION PERMIT Permit No. . ..�.. -. <br /> ---------------- -----------__-_-_--.--------- `(Complete•in Duplicate] Date Issued - -.- <br /> _----- ------ - ----_-..__ . .----..--.---.. This Permit Expires 1 Year From Date Issued ZO(p — too —1f <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. t_4� lty12 : <br /> JOB ADDRESS AND LOCATION.. r - I` 1 _-A-VT`-----------� � <br /> - - -. --- <br /> Owner's Name �.�4t ------ � Phone fi <br /> Address--•----------------------- - <br /> Contractor's Nam - _. f ' Q— ------ �.Phone_. � <br /> 2 ° t k Other <br /> Installation will serve: Residence, Apartment House ❑ Commercial ❑ Trailer Court ❑ Moe ❑ `❑ { <br /> Number of living units: .-I-- Number of bedroom... Number of baths. Lot size. - ---x / -------- <br /> Water Supply: Public system ❑ Community system [] PrivateDepth to Water Table ...... _ ft <br /> Character of soil to a depth of 3 feet' Sand [:] Gravel E] Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date----------_---.-- ) No ❑ New Construction:(YesA No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION-AND-SPECIFICATIONSc -- - - <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) p� <br /> well .-Distance from f ndation----/P-�.-_.Material -C-_v*g! ----------------------- <br /> Septic Tank: Distance from nearest <br /> Size -- - q P. !�}rr _Capacity 12Q <br /> No. of compartments... l� - - -Li uid de th_ <br /> Dispos I Field: Distance from nearest well_i-.[r'...... <br /> Distance from foundation--_ p_.�_....Distance to nearest lot line_-10- -.. <br /> Number of lines..... ............ ..... Length of each line.. . _- `.--/_....Width of trench.��ff------:�-------- <br /> Type of filter materialS .. ---Depth of filter material--- -- -----------Total length---------------/-I:m----------.-. <br />` Seepage Pit: Distance to nearest well <br /> ................------Distance from foundation--------__-------Distance to nearest lot line...__.---....__.. ' <br /> ❑ Number of pits--- - ---------------Lining material------------------°-- Size: Diameter------ ----------------Depth--------- ------------------- <br /> Lam, <br /> Cesspool:. Distance from nearest well ................Distance from foundation....------------- ..Lining material---------------.-------------------I.. <br /> ❑ Size: Diameter- - --------- ----- -- -----------Depth------------------------------- - -----------------Liquid Capacity----`-----------------:----gas. <br /> Privy: Distance from nearest well-.........................._-------------------.Distance from nearest building----------.._...--_.-------_----...._--- <br /> . <br /> ❑ Distance to nearest lot line- ------- ------------ ------------- -------------------- ------------------ ----------------------------- <br /> ., <br /> Remodeling and/or repairing (describe) --------------- <br /> ----- �----------------------------- <br /> ------------------• =--------------- --------- --------------- <br /> i ----- - ----------------------------- ------------ -------------------------------- <br /> 1 ------`-------------------------- --------- -------------- --- <br /> t ------------------ <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, Sta .laws, and r les and regulations of he San Joaquin cal Health District. <br /> .r <br /> Contractor) <br /> ------------------ --------------- <br /> BY :.- --- ---- (Title)---------------- --------------------...... - <br /> ----------------- - <br /> (Plot plan, showing size of lot, location of system in relati to wells, build' gs, etc., can'be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- ---- 4. .s. .------- DATE-------3---i- <br /> REVIEWEDBY---------------------------------- --- ----------------- - ----------------------- DATE-------- --------------------------------------•------------ <br /> BUILDINGPERMIT ISSUED----------------------------------------------------- ---------------------------------------------- DA•TE---------- ------------------------ ------ -------------- <br /> Alterations and/or recommendations:-------r-- ------ ------------------------ -----------------------------------------•--------•------•----------------------------------------------- <br /> ------------------------------ ---------- --- ------------ ------------- -- -- =------------------ ----------------------------------------------------- <br /> --------- -------------------------------------- --------- ---------- -- ------------ •-------------------- ----------------- ------------------------------ ------------------------------------------- <br /> --- . ------ ----------- <br /> I �Q / ------- ---------- -- ----- <br /> FINAL INSPECTLON BY E/)- - . . . - -- ---- ---- Date.............+� { �.r✓ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 1.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California "" 1. <br /> r E.H.9 2M 1.67 Vanguard Press <br />