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APPLICATION FOR SANITATION PERMIT Permit No. <br />(Complete in Duplicate) Date Issued <br />Application is hereby made to the San Joaquin Local Health District for a jnermitfo construct and install the work herein described. <br />This application is made in compliance with 1_­oJrjJty0r it <br />dl',�ance No. 549. <br />JOB ADDRESSLOCATI <br />Ciwner*t N a m e_ <br />.......... one_ ........... <br />Address..- ­/3. <br />Conlrador's Name.. .......... ........ ............. ....... ....... ..... . . .. Phone-. ..... ......... <br />Installation will serve: Residence Apartment House [] Commercial Trailer Court Motel C] other <br />Number of living uni+s- Number of bedrooms Number/ baths Lot size ... <br />Water Supply- Public system F-1 Communll#y system E] Private Depth to Water Table <br />Character of soil to a depth of 3 feet: Sand P-1 Gravel [] Sandy Loam [3, Clay Loam 1`7 Clay Ej Adobe �Ildpan <br />Previous Application Made. Yes F-1 No New Construction: Yes 121"No r-1 FHA; VA: Yes r No f-11 <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />{Na sapfic tank or cesspool permitted if,pubi ic sewer is available within 200 feet.) <br />4a f *,on 119 <br />lcnk: D:siance -Frorn nearest well.ca is"';nqL� frv" fo <br />No. of compartmenis_ __Liqtji6 lepth <br />Dis-.ance from riatares, bistance from foundafion-119 to nearc5t lot )in <br />Number of ;ines_ a ........... Length of each e . . .......... <br />Width of trench.... <br />Type of filter miner; "14-- or th of filter ma ferial ...... total lengih_ <br />� ... . ........ <br />44 <br />See,page P;t: Distance to nearest .... .Dietcnce from founda-lion-r ... ------ Distance to nearest <br />10 Number of pits._.._.___....._.._Lining .........Size: Diameter.-..........-. _Depth_..._ ...... <br />':esspcol: Distance from nea-est well.__........Disfance from Lining material ........ ...... ..... - ------ <br />11 Size: Diari-,e+cr,_. ._........Death......__ .......Liquid <br />Privy- Ns-leince from nearest well.,.......... from nearest .................. <br />Distance to nearest !of line._,_ <br />Remodeling and/or repairing ... ...... . . ......... <br />.......... ­­ ....... ------- I ............. ......... ... . ...... .......... ......... . . . .... . . ....... .......... ............ . ..... ....... ... .... <br />........... ...... .......... ... __-- .--.-......_...._._..w_........... .... ...... <br />...................... ­ ----­-­-­--- ................... <br />I hereby certify that I have prepared this applicaf;on and that the work will 6e done in accordance with San Joaquin County <br />ordinances, State laws, aad rules and regulations of the San Joaquin Local Health District. <br />............. _ ...... .......... ..(Owner and/or Contractar <br />By:__.................. __ ............. .......... ........ ___ ......... * ................ * ..... ........ (Title) <br />(Plot plan, showing size of I*+, location of system in rellailon to wells, buildings, etc., can be placed on reverse side). <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED . ...... . ....... ­­_.__­­.. DATE <br />REVIEWED BY... <br />-----. . DATE_ <br />----------- --- ...... ------------- <br />BUILDING PERMIT ISSUED-_-"" ... . ...... ..­­ DATF-,.' b- * ....... <br />Alterations and/or recornmendations-_.. ....... __ . . .......... <br />. . ........... <br />.... . ..... . ... . ............ ................ .......... .. . .......... <br />........ . .. . ....... .. . ...... .......... ........................ ...... ... ....... ................... <br />FINAL INSPECTION BYL.. <br />�, .. . �..... Date.._....... �: .� ..... _ _............._............. <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />130 South American S4r**4 300 W*lf Oak stevef 132 Sytamore Street 814 North "C" S+roef <br />stocioon, Cal"fom"a Lodi, California Manlaca, California Tracy, California <br />FS --9-2M , Revisoa ;-Si F.Rco. <br />