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FOi OFFICE USE: <br /> --------------------------------------------------------- <br /> ..__....______..-----------------.__.__._---------- APPLICATION FOR SANITATION PERMIT Permit No. .W :...2_l 7 <br /> - - ­--------------------- --------- (Complete-in Duplicate) <br /> ---------------------____._..__. This Permit Expires 1 Year From Date Issued 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, <br /> G <br /> JOB ADDRESS AND LOC TION ----®-��__--��-----'�---- ----�- /1 _ r ---- � <br /> Owner's Name F- W/u L` - lx-fes-- -----------fe_ - ------- Phone------------------------------------ <br /> Address --�-'------------------------------------------------------------------------•------.._---_------------------------------------- <br /> Contractor's Name -------- ---- ------ -------------- <br /> Phone <br /> Installation will serve: Residence g'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [] Other ❑ <br /> Number of living units: _/__ Number of bedrooms _ _ Number of baths.-/--- Lot size ------- <br /> Water Supply: Public system ❑ Community system ❑ Private Zf-'Vepth to Water Table�e ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ®"Aclobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date................... ) No New 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 /> —A_W jE 1A No. of compartments.................... Size------------------._ -----------Liquid depth_---- -- ------- ------- Capacity <br /> i <br /> Disposal Fie d•r Distance from nearest well... ..__�.' ____Distance from foundafiion ��.-_.___..Distance to nearest lot line____- �____. <br /> � Number of lines ---- Length Length of each line__ Z_4~ <br /> / -Width of trench •Z <br /> `� Type of filter material _ _jl Depfih of filter material_._, __.___.__..Total length_____ ` .���___ ________________- <br /> Seepage Pit: Distance to nearest well_. .. Distance fr foundation____ -- <br /> - - - _a�._.__..DistanOle to nearest lot life__. ______.._ <br /> �` Number of pits___ ..�'_._..__._.__Lining material___ Size: Diameter__** -9___....__Depth_. ti --�---------------- <br /> Cesspool: Distance from nearest well ________________Distance from foundation---------- ------ Lining material__--._.._._.__...__.._._____--_______ <br /> ❑ Size: Diameter_ __ .-------- <br /> ----- ---------- Depth------- ------ -- --------------------------------Liquid Capaci#Y...----------- -------------gals. <br /> Privy: Distance from nearest well-------------------.-------.-----.---------------Distance from nearest building------------------ ._________________... <br /> ❑ Distance to nearest lot line ...-- <br /> Remodeling <br /> ine ...-Remodeling and/or repairing (describe):----- �_ J� '----------- -------------•------•-----•-- <br /> ---------------- <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)--------------- --------------- ---- ------- --------- --------- (Q%naa-spd�or Contractor) <br />_ BY: - -----•- --- -- --- -- -- - ----- ...... <br /> (Plot plan, showing size of lot, location of system i ation to wells, buildings, etc., can be placed on reverse side): <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_._._ _ __. __ . _ _ --------- ------------------- <br /> ------------------------------- ----- DATE__. -------- ----------------- - <br /> REVIEWEDBY----- --------------------------------------- .----------------------------------------- ------------- ---------------------- DATE------ ---------------------- ---------------------------- <br /> BUILDINGPERMIT ISSUED-------- -- ------- --------------------------------- ------------------------------ ------------- DATE----- --- ------------------------ ------------------------- <br /> Alterations and/or recommendations:-------------- ...... -- ------- -------------- --------------------------------------------- ------------------- ---------- <br /> ----- ------------------------------------------------------------------­ - - ---------------------- --------- - ---------------......... -- -------- -- ------------- ---------------------- ----------------------•-•- <br /> FINAL INSPECTION <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazellion Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br />