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FOR OFFICE USE: ip G <br /> ------------- APPLICATION FOR SANITATION PERMIT Permit <br /> ` - `�-7---- ----� ----- (Complete in Duplicate) <br /> .___.._- This Permit <br /> 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 <br /> t F3C--o-unO"` N 549.49. <br /> JOB ADDRESS AND LOCATION_____ ?-----•---------- -------------------I <br /> - <br /> Owner's Name ✓ _- ------ ------------- Phone-----------•--------------------•--- <br /> Addr s-------------- ` ........a <br /> Contractor's Name------------------------ ---------------T •--•---------------------------------------- -• -----.._ ---------•------------------------- Phone----------------------------------- <br /> Insfallafion will serve: Residence [Apartment House [ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __2—. Number of bedrooms-3----- Number of baths 2___-_ Lot size __`rD ----O° <br /> Water Supply: Public system ff"Community system ❑ Private ❑ Depth to Water TableS4779._ ft. <br /> Character of soil to a depth of 3-feet `'Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 'fay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,ddte---_ _ ..-. .__--] No ❑ New Construction: Yes ff�­No ❑ FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ` <br /> (No septic tankoor cesspool permitted if public sewer is available within 200 feet.) <br /> a } <br /> Septi ank: Distance from nearest well_______________Distance from foundation-------------------Material_-_.___..____...___.__-_---__-__--_______.____. ,r <br /> No. of compartments--------- ---------------Size--------------------------------Liquid,depth--------------------------Capacity-------------- -------- W <br /> Disposal Field: Distance from nearest well!---_—------Distance from foundation_-/�7-'___------Distance to nearest lot Iine_S___.____.� <br /> Number of lines___________I <br /> ___ __ __ ..__Length of each line___ __ ._ <br /> _ -_______-_.Width of french------_ _? <br /> -- ---------------- <br /> TYPe of filter mate'rial_ W01t---------Depth of filter material-_ .----------Total length 'TS� --- -------------- <br /> Seepage Pit: Distance to nearest well-- ----------------Distance from foundation---!a-----------Distance to nearest lot line-_._`��__._,__ <br /> 2i� Number of pits-----------------_# Lining materia' 1___4 _____...Size: Diameter------3_.3_ p 671 <br /> Cesspool: Distance from nearest well_______________Distance from foundation--------------------Lining material_-._____---_-_.__--__ --------------- <br /> ❑ Size: Diameter__ -------------------------------Depth---------------------------------------------------Liquid Capacity__----------------------gals. <br /> Privy: Distance from nea est well------------------------------------------------- from nearest building----------------------------------------- <br /> F-1 <br /> .._._.- ____________.____.._❑ Distance to nearest lot line------------------- ------------------------- - -------------------------= <br /> Remodelingand/or repairing (clescribe):---------- ------------------------------------------------------------------------------------- ---------------------------------------------------- <br /> I <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 ano regulations f e San Joaquin Local Health District. <br /> (Signed) � J �T <br /> - - (Owner and/or Contractor <br /> )- ----- - ---- <br /> BY= :------------------------- ---------------------------------------------------------(Title)-----------=- ----------------- - --- - - - - ---- ----.--- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> F r <br /> FOR DEPARTMENT USE ONLY ,? <br /> APPLICATION ACCEPTED BY----- __ ---------------------------------------- DATE-----'`�- 67---.__.-__ <br /> ---------------- <br /> REVIEWEDBY '- -- ----------------------V------------------------------------------- --------- DATE-------- -------------- <br /> ----------------------------------- <br /> BUILDING PERMIT ISSUED ------------------ ----- -- �= ---- --------------I/ - ----------- - <br /> .._ r DATE----------------------------------- ------------------------ <br /> Alterations and/or recommendations-_ --- <br /> ___ � <br /> __ _____:�f_.-� " ���� <br /> __r� _____ ________________________________._ <br /> ------------------------------------------------------•-------------------------------------------------------------•-----------------------•-------•-------•----------------------------------------------------------- <br /> ----------: -------------------------------------------------------- ------- ------ - ----• - ------------------- ---------------------------------------- ----------------------------------------------- --- <br /> FINAL INSPECTION 'BYc-. - - ---------------- ----- ------- - -- ---------- Date--- --- --- -------- ------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street ' <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> F.P.CO. <br />