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FOR OFFICE USE: <br /> ----------------- ----------------------- -- ---- ------ �.3a- <br /> --------------------------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. ............:........� <br /> ---------------------------------- --------------------- (Complete in Duplicate) <br /> Date Issued <br /> --------- This Permit Expires I Year From 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 /> s <br /> JOB ADDRESS AND LOCATION e C>. /J ���;�F-------------------- <br /> Owner's Name--- = /�. ----- .-- Phone_ <br /> jj <br /> Address-------------------C?�Q_e��.J-------. '---------------------••-- -) -- ---------------------------------------------------•----.--------------•--•---------------- <br /> Contractor's Name.... „----sre ------- i �. 1 -.- # �/tl °� Phone1'_e0f0..?40__7--- <br /> Installation will serve: Residence [Apartment House ❑ Commercial El Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units. � -- Number of bedrooms _._ Number of baths Z__-- Lot size __ _.ca7Q0__________________ <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water;Table ________ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ VClay Loam gg­Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date-------- -----------) No � New Construction: Yes ❑ No 20'� FHA/VA: Yes ❑ No 9+- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: r r <br /> (No septic tank or cesspool permitted if.public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearestlwell_________________Distance from foundation------------------- Material__.-------------------------------.-------------- <br /> ❑ No. of compartments Size-------------------------------Liquid depth.------- ---------------Capacity----------------------- <br /> Disposal Field: Distance from nearest well_.!__ __ Distan«ce from foundation._/�J__. �__ADistance to nearest lot line_`'�__--_.__. <br /> —/ !fel----- r <br /> Number of lines--------�------ --------------Length of each line._-- Q-_-------------"---Width of trench---' ��:--F,-----------.- <br /> Type of filter material-_�r '..._Depth of filter material__. -_Total length--------- �__�______________________ <br /> Seepage Pit: Distance to nearest well ______Distance from foundation--------------------Distance to nearest lot line.._____..-._---.- , <br /> IF <br /> ❑ Number of pits-------------- --- ---Lining material-----------........... Size: Diameter,----------------------Depth--.----------------------------- 1:�3, <br /> Cesspool: Distance from nearest well---_----------_Distance from foundation-----------___-i---Lining material__-_.___---_____..__-___---_-._-. <br /> Size: Diameter--------------------------------------De th---------------------------------- _. --r*k-Li uid Capacity gals. <br /> Privy: Distance from nearest well _______________---------------------------..___._Distance from nearest building-..--__._.________________________.__... <br /> ❑ Distance to nearest lot lire_--- ----------- ---------- ------------------­----- -------------------------------------------------- <br /> Remodeling and/or repairing (describe):----__- ------ —'e, -------------- <br /> I <br /> ----------------------I-----------------------------------------------------------------------------------------------------t-----------•--•----------------------------------------------------------------- <br /> ------------- <br /> S <br /> I hereby certify that I have prepared this application and that the wor 'I be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules a re tions of the San Joaquin oc "Health District. <br /> Signed) �+= _ --------------!��Q,f - L< -- � �------ - - Ow r and/or Contractor <br /> -- Title ---------------------- ------- ---- <br /> (Plot plan, showing size of lot, locatio f system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY � Y\------------- ------------------------------Z---`--------. t � <br /> ------------------------ DATE--- - -A------b----------------------------------- <br /> REVIEWED BY--------------------------------- <br /> ------- - ---------------------------- ---- --------------------- ----------------------- DATE <br /> BUILDINGPERMIT ISSUED--------- -------------------------------- ---------- -------—-------------------------------------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations----------------------- ----------------------------- ---------------------------------------•------------------- ------------------------------------------- <br /> ---------------------------------- ---------------- ------- ------- ----- <br /> ; ---------------------------------------------------------------------- <br /> --------------/,,Q -- �P/w------------ 4-__,.o ------°?0_ k6-- - --------�------�---�•----------------------------------------------------------------------- <br /> viFINAL INSPECTION BY:. - ------------------- bate <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1801 E.Harelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />