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APPLICATION FOR SANITATION PERMIT Permit No. <br /> --- -- ------- ----------------- ------ -- (Complete-in Duplicate) <br /> Date Issued ._ <br /> - ----------- -- ----- _._._.._------ ------------ --- This Permit Expires 1 Year From Date Issued /s <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 /> JOB ADDRESS AND LOCATION_{ . ___.. „----- <br /> Owner's Name------ t'I- -ej--------/ -e-1. -- ------ P one------------------------------------ <br /> Address � _ = ---------------- -- <br /> ---- <br /> Contractor's Name.---- ------------- ------- - -------------- ----------------------------- Phone------ . ---------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _/_._ Number of bedrooms_ Number of baths ,2.._ Lot size ----------------------- <br /> Water Supply: Public system ❑ Community system ❑ Private kq- 5epth to Water Table 4ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay dobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date-------.._......_.. ) No New Construction: Yes �o ❑ FHA/VA: Yes [L- No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer It is available within 200 feet.) <br /> Septic Tank: Distance from nearest well_. ._ Distance from foundation../ -----------. <br /> [ '' No. of compartments__ <br /> ............ ___~ _ jets Liquid <br /> �. .r v � <br /> Disposal Field: Distance from nearest well_�..�......Distance from foundation-../_Q_.___..Distance to nearest lot line_-�_ .._____ <br /> Number of lines _-_� ..._. ength of each line_ -�._._. Width of trench.�_`____ ___________________ <br /> /y���r01 <br /> Type of filter material 6 . Depth of filter material.._ ___2____.__.__-Total length...e��_.0 _____-_.___________ � <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line__._____-_____.__ <br /> ❑ Number of pits... .........---------Lining material......--------------- Size: Diameter-----------------------Depth-------------------.____-.._____ <br /> Cesspool: Distance from nearest well ________________Distance from foundation...._...___-_____ ..Lining material_.....--______._____._--_--____._____ <br /> ❑ Size: Diameter. -- -------- ----- ----------------Depth----------------- --------------------------------Liquid Capacity. ------------ ------------gals. <br /> Privy: Distance from nearest well..----- .......---------- ----------------------Distance from nearest building--_.=._'-_.----._-------------_--------- <br /> ❑ Distance to nearest lot line ----------_------------------- _ ________ _ <br /> Remodeling and/or repairing (describe):----- 1 '�C41-- 1_a � -�---- -J�-------'1--•--- --- <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 /> • <br /> Al' �°r Contractor) <br /> (Signed) - - --------------- ----------- <br /> - ) <br /> �.... ..._. ._. - - <br /> (Plot plan, showing size of lot, loc n of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - -- DATE --�Z...=6- <br /> REVIEWEDBY----------------- ------------------------- ------------------------------------------------------ ---- ---------- DATE----------------- ----------------------------------------- <br /> BUILDINGPERMIT ISSUED----- -- ----- ----------- ---- ---------------------------------------- ---------------- DATE----------- ---------------- -------------------------------- <br /> Alterations and/or recommendations:........ ---------------- ---------------- --- <br /> ------------------------------- ------------ -------- --- --------- ----- ---------------------- ----------------------------------- ------------------------ --- ------------------------•----------------------- <br /> ----------------------------------------- -------- -- . . -- ----------- ------------------- ------ --------------------------------------------------------------- ------- ---------------------------------- <br /> --------------------------- ------- ---...-------- ---------------- -------------- .._... ------------ -------------------- ------------------------------------- •------------------------ <br /> ------------------------ -----I--- ------------------------ --- ---I-- --------------- -------------- -------------------------- ----------- ----------------------------------------------- ------------------- <br /> FINAL INSPECTION BY:. - J� /�/t/ Date ......--- jL�: U------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Slockton,California Lodi. California Manteca, California Tracy,California <br />