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rkjKvrrik-t UOL: <br /> --------------------------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. �L _S <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 fora permit to construe rid instal# t work h in describe <br /> This application is made in compliancewithCounty Ordinance No. 549. <br /> JOB ADDRESSIND LOCATION (C: r _ ._ _© �_ --•----------- -- 1.- <br /> Owner's Name- <br /> - ------------------ ----- <br /> - ---------------- <br /> Address-------------------------------- <br /> --- <br /> Contractors Name'---�@y_9 . 4A:�___ 4`�.-----Q -------------•--------------- --- - -------- PPhhoann ea.�.0__Q <br /> Installation will serve: Residence Day_*. <br /> ! <br /> House ❑ Commercial ❑ Trailer Court ❑ Motel 0 Other ❑ <br /> Number of living units:1------- Number of bedrooms _,2--<mber of baths _/... Lot size -.._i.___- ---------------- <br /> Water Supply: Public system ❑ Community system ❑ Private [�epth tc, er Table ----- -- ft. <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......... ..........1 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 /> ST Distance from nearest well________________Distance from foundation------------------ Material_____.-----..__.___.---.___-__---.-_-.Olt: .___..._. <br /> eNo. of compartments------ ------ ------------ ize--------------------------------Liquid depth--------- ---------------Capacity-----------`------------ <br /> s si I 1 Distance from nearest well. -------Distance from found n_fa��S__..�Distance to nearest lot line-._!-_�.- <br /> 1 Number of lines---- ,_.__�.f Length of each line ll_. FQ...Width of trench__ ��___._..f___.__ <br /> Type of filter materia .-.-De th of filter material_-_1_. <br /> Yp - - --� p �-------------Tota! length-----------------j�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----------------------_------.-_- �r <br /> Cesspool: Distance from nearest well-----------------Distance from foundstion__-_-----_________.Lining material-------------------------------------. /X <br /> F-1 Size: Diameter--------------------------------------Depth----------------- --------------------------------:Liquid Capacity----------------------------gals. <br /> ®® <br /> Privy: Distance from nearest well________ -----------------------------------..-Distance from nearest building------------------------------------------ <br /> F1 Distance to nearest lot line--- - ------------------------- - -------- <br /> Remodeling and/or re airing (desc 'be)--- ----- --- ----------- ------- -- --------------------------------- -- -- ---------------•-------------------------------------------------------- <br /> -----------------•---------------------------- ---------- ---- --------- ----------------- - -------------------- <br /> ----------------- <br /> - --- -- ----------------------------- - --- <br /> - <br /> - -- -- ------- <br /> ------------------- ----- <br /> ----------------------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this ap lication and that the work wil be done in accordance with San Joaquin County <br /> ordinances, Slaw ane! rul and regulation of th San Jo uin Lo 1 H Ith District. <br /> [Signed] M,-------------- ------------------( r►ar�'�[or Contractor) - <br /> By:------------------------------------------- ---------------------- ------ ----- ----------[Title]------ <br /> [Plot plan, showing size of lot, location of system in relati to wells, buildin etc., can be placed on reverse side]. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --- -- --- DATE - -- - <br /> ----------- <br /> REVIEWEDBY--------------------------------- ....... ------------------------------------ --------------------------------------------- DATE <br /> BUILDINGPERMIT ISSUED-------•---------------------------------------- ------------•--------------------------------------- DATE--------------------------- <br /> Alterations and/or recommendations----------- ----- - ------•------------ ----------------------------------------- ----------- <br /> --------------------------- ----------- ------------------------------- -------- -----------------------------•----------------------------------------------------------------- ------------------------ --1­ <br /> ---------------------_- - -- ---------- ----------------------------------- ------------------------- ---- ------- -----------------------------------I- - ------ -------------------------- -------- <br /> 3 - 30 -C - <br /> FINAL INSPECTION BY: - _"� ............. -------- -- Date--- ------------------ ------ ----------- - ---------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.HaWton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.CO. <br />