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FOR OFFICE USE: <br /> ------------------ ° <br /> ---- ------------------ --- -------------------- --- <br /> APPLICATION FOR SANITATION PERMIT Permit No. _ _d� 6 <br /> -- - ------------ --------- -------------------- ------- (Complete in Duplicate) <br /> Date Issued <br /> --------------------------------------------_-----._._._ This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permittoconstruct and install the work herein described. <br /> This application is made in compliance with County Ordinance No 549. <br /> �s f <br /> JOB ADDRESS AND LO TIO -------- --- --- ----------------------------------•-------------------------------- <br /> Owner's Name----------- � Phone------------------------------ <br /> ------- <br /> Address------------- - Gr e-------- n'-• -------------------_-----------------•---------------- <br /> Contractor's Name-------------- t+ ----------------- Phone----------------------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> h i � <br /> Number of living units: __/__ Number of bedrooms __ Number of baths _/'f___ Lot size ----------------------------- <br /> i <br /> Water Supply: Public system Community system ❑ iPr ate E] Depth to Water Table , it. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2e_'Aardpan ❑ <br /> Previous Application Made: {If yes,date--------------------1 No'��New Construction: Yes No ❑ FHA/VA: Yes ®r 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 wel _!=.._ Dist_ance from fo ndation__,�P---------MatefsI__,�rz/___ <br /> No.:'.of.compartments-..-.;Z....... a, ------Liquid depth--- ------------CapacitY- --- ----- <br /> I. <br /> ----- Size: <br /> Disposal Field: Distance from nearest well.-.--— Distance from foundation__/�t/_____.Distance to nearest lot line-W4.__ <br /> Number of lines_____________ -__-_- Length of each line__ __ -----Width of trench �V <br /> �- ,. <br /> Type of filter material � De th of filter material-_ _._.Total length__ -- fir, <br /> rp iG -��----- <br /> Seepage P t: ,Distance to.nearest well-------__^_._.--_--Distance from fo dation__' ' __-.___. �s ante to nearest lot lin _4-__________ <br /> k 2 1 <br /> 1KrNumber of its___. ._ Linin mdfe�r,al .Size: Diameter .___-__-Deptn _ __._._ <br /> p g <br /> Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material-------.---------------___.__.______. <br /> ❑ Size: Diameter--------------------- ---------------Death------- --------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well------_---------/--------------------------- .Distance from nearest building--.._.___.________________.._.---...._. <br /> ❑ Distance to nearest lot 1ine------------------------------------ - ----------------------------- --- --------------------------------- <br /> ---------------- <br /> Remodeling and/or repairing (describe) --- >/.`` , -- ----------- <br /> - <br /> ---------- <br /> ------------------------------------------------•-----------------------------•------------------------------------------------------------------------------ ---------- ------------------------------- ------ <br /> ------------------------------------------------------------------------------•---•----------------------------------------------------------------------------------------------------------- <br /> a <br /> -- ---------------------------------- --------------------------------------------- ----------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)----------------- ---------- ------------------------ ---- ------------------- -----------------------:( r or Contractor) <br />,. Sy:-------------------------------------------- -----(Title) -------- - - ---... - 1 <br /> (Plot plan, showing size of lot, location of system in lation to wells, buildings, etc., can be placed on reverse side). <br /> y <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - ------ ----------------------- ------ ---------------------------------------- DATE..--- 'S- d-l�6- ------------------------------- <br /> REVIEWEDBY-------------------------- . ..---- - ----------------- -----------r------------------------- DATE_---------------------------------------------------------- <br /> BUILDING PERMIT ISSUED------------------- -Ok------ X�rr/.�--�` �-ls�... DATE._ <br /> Alterationsand/or recommendations-------------------------- --------------------------------------------------------------------------------- -------------------------------------------------- <br /> l G <br /> FINAL INSPECTION BY ! ---------- ------ Date---------r'-r°1 _ �f`t <br /> SAN-'JOAQUIN LOCAL'HEALTH DISTRICT U <br /> ­_ <br /> 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> tl <br />