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FOR OFFICE USE: <br /> Permit No. <br /> ------- APPLICATION FOR SANITATION PERMIT <br /> ---------------- ----- �` _ o ; <br /> (Complete•ln Duplicate) Date Issued <br /> -- --- - ----- -------_- ._-_ - _-__-_---_,--- This Permit Expires 1 Year From Date Issue <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 549. <br /> 3 <br /> JOB ADDRESS ANCAT1 N-__- Q --- <br /> -- - - <br /> --- ------ --------- -------------------- <br /> 141 <br /> ------- -- <br /> ----- <br /> ------------ <br /> Owner's <br /> _Owner s Name---- - ----------- __ <br /> ---- ---- --------- -- ------------------------- <br /> a <br /> - /I f.... - ------ -- ----- ----•--------------------------------------------------•------------------------------------------------------------------------------------- <br /> Address------ -----••• .. <br /> ? ------�-. Ph ---- <br /> � one.�� --- <br /> � Q7 <br /> - - ----•------------ <br /> Contractor's Name_ ----- -- - ; <br /> - Motel ❑ Other ❑ <br /> Installation will serve: Residence R] Apartment House ❑ Commercial ❑ Trailer Court ❑ Lx �k1 <br /> IQ ----------------- <br /> Number <br /> -- -------- <br /> Number of living units: _- -1--- Number of bedrooms jr_._.- Number of baths-� Lot size <br /> Ciommunit system ❑' Private ® Depth to Water Table T+ a ffi r <br /> Water Supply: Public system F1 ,Community Y <br />' Character of sail to a depth of 3 fee Sand ❑ Gravel ❑ Sandy Loam [I Clay Loam [I Clay 0 Adobe E] Hardpan ❑ <br /> ` I -------- - ----- } No ® New Construction: Yes ❑ No Q FHA/VA: Yes ❑ No <br /> f En <br /> Previous Application Made: ;If yes,date - <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 /> ❑ No. of compartments------------------------Size--------------------- -------•---Liquid depth---- ---- ------- --- ---.Capacity <br /> r <br /> t pisposal Field: Distance from nrearest welL��UI---Distance from foundation_,�_L.7�___.-_--Distance to nearest lot line-A2--_____-. <br /> f lines------- -�---- -----------------Length of each line :`��p--------------.Width of trench--_.-A�.-.--------------- <br /> Number o ,�} �/ a s — ------------------- <br /> i Type of filter material__, 04!? ....Depth of filter material_. -------------Total length-___ D <br /> i24 <br /> Seepage Pit: Distance to nearest well__-.fQ�-r- Distance frim.foundation-_ �1___ hance to nearest lot ��-------- <br /> --------- <br /> k ® Number of pits 9 <br /> .Linin material-__ ._-O.GI --.. Size: Diameter-_ - R <br /> r. Cesspool: Distance fiom nearest well _____- Distance from foundation..._.___-_..--- ..Lining material----------------_--- '_-�'._.___-_ <br /> _Liquid Ca acit- gals. <br /> ❑ Size: Diameter. -. - --------- -Depth--------------- --- - -------- ---- q p Y------------- ------------- . <br /> I ------- --..Distance from nearest building--------------•--------------------------- <br /> Privy: Distance from nearest well.................. ... <br /> ❑ Distance to nearest lot line ------- ----------------- <br /> ----- --- -- --- ------------------ <br /> - --- -------- ------------------ <br /> ------- ---------------------------------------------- <br /> Remodeling and/or repairing (describe):--- - - <br /> ­ <br /> --------------------------------------------------------- <br /> r -- --------- <br /> I ----------•------------------------------------------------------- --------•-------- --------------------------------------------- ------------------ <br /> =------------------------- <br /> ------------------------- <br /> ed Ais <br /> done <br /> [ ordinancesb5tate certifythat <br /> have <br /> regulations application <br /> the San Joaquin LocalkHeall heDisfr cfn accordance with San Joaquin County <br /> (Signed) - - .. —"`_.__' ----- ----- ----- - <br /> ----(Owner and/or Contractor) <br /> - <br /> ' '�--- - -------- ---- ---- ----- ------------- <br /> yl--------- --- ---- - (Title) <br /> (Plot plan, showing size of lot, location of system in relation to well buildings, etc., can be placed on reverse side). <br /> 1 FOR DEPARTMENT USE ONLY t <br /> DATE -- `{' ( ------------------------ <br /> APPLICATION ACCEPTED BY---.-------` � !��------- ------------- -- <br /> ------- --- <br /> DATE-'`.. <br /> ------• -------------------------------------- <br /> REVIEWED BY---- ------------------ ------ ----------------------------------------------------p-------------------- <br /> DATE. -- ._ [ - <br /> BUILDING PERMIT ISSUED-------- - --------------------------- ------------------------ --------------- - T <br /> Alterations and/or recommendations:----------------- <br /> ------------------------------------------------------ <br /> ---------------------------------- <br /> t - <br /> FINAL INSPECTION BY:.._._._.___---.:_-.._.____- L - <br /> Date- T ---------- ---------------------- <br /> : SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hatelion Ave. 300 West Oak Street 124 sycamore Street 205 West 9th Street <br /> Stockton,California <br /> Lodi. California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 vanguard Press <br />