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FOR OFFICE USE: <br />APPLICATION FOR SANITATION PERMIT r Permit No. 0. a2-.....•. <br />- <br />..................... ----- ---- -------- <br />(Complete in Duplicate) - r <br />.......-.... •-----•.................................. Date <br />........ ............ ._:._......... This Permit Expires i Year From Date Issued <br />Application is hereby made to the Sen Joaquin Local Health District for a permit to construct and install the work herein described. <br />This application is made in compliance with County O'kance No. 549. <br />'.�4��- /� -4 -------------••-•.--------.---•-----------•••-.._--- ......... <br />JOB ADDRESS ANDLOCATION.!-_- ---- <br />._ <br />Phone------- --------•---••-.-------.- <br />r.........- <br />Owners Na244a,4,4 <br />Address.�...................... ...... -...................................... ---------- <br />Contractor's Name .... •__ 5 h Phone.........------- --------- -------- <br />Installation will serve: Residence ❑ Apartment House 171 Commercial C] Troller Court ('Motel Other C1 <br />Number of living units: /Q... Number of bedrooms _-« Number of baths -!.l%. Lot size --•-•------ ------•-- <br />Water Supply: Public system ❑ Community system ❑ Private jjl' epth to Water Table <br />Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ®''Hardpan ❑ <br />Previous Application Made: (If yes date_..-_-.-.- --.) No 2q`- New Construction: Yes ❑ No FHA/VA: Yes ❑ No <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank or cesspool pIermitted if public sewer is available within 200 feet.) <br />Septi ank" yY Distance from nearest well.................Distance from foundation.__.:..........._....Materia._.................. __.__.___.. <br />�V No. of compart� ents_-----. -----• --- Size__. Liquid depth Capacity ....................... <br />• r r <br />Disposal Fi Distance from nearest well..,-..._-: Distance from foundation.. A?-.--.._•••••Distance to nearest lot line'-.677! ...... <br />.4 �. <br />jtK-If- ._ ----•- <br />f Number of lines:--•-- �•---....----•-----..•.._.. Length of each line ✓"`l7._� •-� ---•• Total hien length ncsd'._-:...-•-•-•---•- <br />.-.... <br />Type of filter materia4�Crk..•.---••-Depth of filter material..----�--.�•--- 9 � <br />y <br />Seepage Pit: Distance to nearest well...�B_7._..._._..Distanc from foundation%.d....___._....Disfi�nce to nearest 4ofi line_._.._.....__._ <br />Number of pits - *q ............... Lining material- �?. -/.�.-...Size: Diameter ..- A...__.__.-..-- Depth......�.t�.-........--....... <br />Cesspool: ,,.'Distance from nearest well.................Distance from foundation._._.._..._..._....fining material __...--- ------------ <br />Cesspool: <br />. ...._..Liquid Capacity ........... ................. g <br />❑ Size: Diameter _--•---..-.--••---•------••-------- Depth---------------. --- ---- ••-•---•-----•- <br />$,• <br />_...........Distance from nearest building....-.-.----.-.-•---•----------•--•------- <br />Privy::� :• Distance from: 'nearest well..---- .•-•........................ <br />❑ 'W4 Distance to nearest lot line...--._---------- • ------ -- --------------•---•- <br />Remodeling anb/or repairing (describe}:---------------------------------------- <br />•---••-------•-••-............................... ............ <br />•-•--.....----- t y <br />-------­­ --•------•-----••--_-... _._.......-... ._..... <br />................ .... •............ ........... ._.................................. --•••• <br />------------------ .............. ............. ------------•— •---••---•...--------•...--------•------------------------------------------------ <br />ty <br />I hereby certify that?�e"nd <br />a prepared this application and that the work will be -done in' accordance with San Joaquin un <br />ordinances, State laws, aregulatio f t San J equip Local Health District. �M1 <br />I:............. ....(Owner and/or Contractor) <br />' <br />BY=----------------------- - <br />i (Plot pian, showing size of lot, loc tion of system in relation to wells, buildings, etc., can be placed on reverse side). <br />F R DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY-.-"-' • . - ._ •-•------- •---•- DATE..... ---------- --------------- <br />REVIEWED BY........ <br />•---•....... .......... . ----•--- -•-.._.... -• .....------..--..... ... <br />DATE ..... ------- ..•- ------ ----- ------------- -------------- <br />BUILDING PERMIT ISSUED ......... .......... •. ......... - -•• -•-- -- <br />------ DATE., .... .. ......................................... <br />Alterations and/or recommendations:._......:. , <br />•.............-------- -- ............ _-- ........ . <br />1 <br />---••.................................... I—— - <br />.... <br />FINAL INSPECTION BY:,.Date.----- .. � '� � .................••-•........ <br />.. <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1601 E. Haso1►on Ave. <br />300 West Oak Street 124 Sycamore Street 205 West 9th Street <br />Stockton, California <br />Lodi, California Manteca, California Tracy, California <br />F.P.CO, <br />