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F FOR OFF USE: ` <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> -._ .... [Complete-in Duplicate} _ S� <br /> -Date Issued ------------- <br /> -------------------- - <br /> ----- ------------------------- ---- - -----------_---------- --- This Permit Expires 1 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 NQ. 549. <br /> JOB ADDRESS A D OC TION - <br /> Owner's Namey - - ---- :•----- ---------- --------------------------- ---------„Phone---------•-•--------•---•-------•--- <br /> Address-----------I---------------- � � -------•-------- ------- ---------•-'---------------------•----•--•-------------- - -----­-­------------------ <br /> Contractor's <br /> ---.. -. --•-----•--•-----Contractor's Name------ - -------- S <br /> `---- ---- <br /> •-- ---- Phone.....:! '� _ <br /> Installation will serve: Residence ❑ Apartment House [D Commercial ❑ Trailer Court ❑ Motel [j Other ❑ F <br /> Number of living units: __5�Number of bedrooms -... Number of baths _ Lot size -- <br /> Water Supply: Public system ❑� Cbmmunity system. ❑ Private' pth to Water Table ft„ <br /> Character of soil to a depth.of 3 feet•-.Sand ❑ Gravel [] S dy Loam ❑ Clay'Loam ❑ Clay ❑ Adobe a-lHardpan ❑ <br /> Previous Application Made: (If yes date__._:._.-----, . ) No New Construction: Yes ❑ No Lf FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:f <br /> I (No septic tank or cesspool permitted if'publicrsewer is available wif}in 200 feet.) <br /> kSeptic Tpir. Distance from nearest well____._.-Distance from foundation---A-----------Material -- <br /> } No. of compartments... :....__.__ Size-3' .-._ ...o J ___Liquid depth_____ _______ ________Capacity e-U. !_q! -.-_. <br /> Disposal Field: Distance from nearest well.:...___ Distance from foundation--------------------Distance to nearest lot line----------------- <br /> ❑ Number of lines.------------ --------------------r.Length of each line-----------------------------.Width of trench------------------------------------ ISX <br /> Type of filter material....,._.---------- of filter material----------------------Total length-_-------------------------------------- <br /> I <br /> I Seepage Pit: Distance to newest well------� .-_..-__Distance from foundation...................,Distance to nearest lot line..-..__-..-._._ <br /> [] Number of pits-} --------------..-'Lin'ing material------_-_------------- Size: Diameter-----------------------Depth---------- -..-----------------=- <br /> fCesspool: "� Distance from nearest,.well -.._--. :`Distance from foundation---------- ---- --Lining material...------ -----------------......... <br /> ❑ Size: Diameter. j -- ----------------Depth-• ------- ----- ------- -------------- -----Liquid Capacity. ------------ -------------gals. <br /> l �tl <br /> Privy: Distance from nearest well---------------------- .. ......Distance from nearest building......_.-...-------------.._--._...____-. <br /> ❑ <br /> Distance to nearest lot line -------- ---- - ------ ------------ ---------------------------- ------------------------------------------------------------ <br /> ( <br /> Remodeling and/or re escribo}:--_---------- -------------- t <br /> — ` c_ ; ---------------- <br /> I <br /> -•-----•--------- ------------------------------- ---;,.,, ---- ------------------------- <br /> --- <br /> ------------- --------------- --------------- ------ <br /> - <br /> ----------- - -----•-------------------------------------- ----------------------------------------------------------- <br /> ! hereby certify that I ve prepared this pplicatian an +ha+ the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and ides d regula i s o he Sa Joaquin Local Health Dis+Tilt+. <br /> I -----.-...-.Owner and/or Contractor <br /> (Signed)--------------- ------ - -- - ---- --- `•-•• --- - ---- - �---.- ---------- ---------------- --- ------------------- - - � � ) <br /> By:-------------------------------- -------- ---------------------- -I -------------- --- --------------------------------------(Title)-- ------ ----- - ----- - ---------- - <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> a <br /> FOR DEPARTMENT USE ONLY <br /> I ,® <br /> APPLICATION ACCEPTED BY---- ---------- '!_--- ------------------------------------- ----- DATE-------- f --------------------- <br /> REVIEWED`BY--------------y-------------------------- - w----------- ------- -----I- ------ --- ------------ ------ ------ DATE---------------- ------- <br /> BUILDINGPERMIT ISSUED-------- -- --------"------------------------------------------------------------- ---------------- DATE--------------------------- <br /> Alterations and/or recommendations: ........ ......... - ------------ --- - ----------------------------------------- <br /> .c .. F ----------------------------� �----- -- --------------------------------- <br /> -----•---------------------------------- -------- ----- ---------------- ------------- - - ------ --------------------------------------------------------------------------- - --------- <br /> .---- <br /> .------------------------- <br /> -------------------------- ------- ----------------------------- ----- --- ---- -- ------------------ <br /> cd <br /> FINAL INSPECTION BY------------- `=----------------------- - --- ---.-. Date-------ii! _. /=4�- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelion Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street <br /> Stockton,California Lodi. California Manteca,California Tracy,California <br /> E.N.9 2M 1.67 Vanguard Press <br />