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FOR OFFICE USE: <br /> �p-- --------------�r� 'T ~� _ <br />-------------------------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. .caa�YZ/--2 <br /> ----------------------------------- (Complete in.Duplicate} <br /> Date Issued .0--- <br /> : _=/ 6 <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 No. 549. I <br /> JOB ADDRESS AND LOCATION--- -X , ------------ --------------------- --------------------- <br /> ------------- --- <br /> Name--- `S- Phone <br /> ---- <br /> -------------------- <br /> Address 5 --------------------------------- ------------------------------------------------ - <br /> --------------- <br /> Contractor's Name Phone------- ------------ <br /> Contractor's <br /> will serve: Residence U I Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ---I---- Number of bedrooms --'3-- Number of baths -_l._._ Lot size _._-_.�.d_. --------------------- - a„ <br /> Water Supply: Public system ❑ Community system ❑ Private 0 Depth to Water Table -3�J ft. <br /> Character of soil to a depth of 3 feet: Sand N("-Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (It yes,date--------- ----------) No ❑ New Construction: Yes "I' No ❑ FHA/VA: Yes ❑ No E] <br /> t <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer <br /> wer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well_ Q__-__Dis#ante from foundation---- Q____.___ Material_____ ..__ ------------------- <br /> - � Sxl -----Liquid depth----- /�'�-------Capacity----�ac---- <br /> Disposal Field: Distance from nearest wellS� Distance (/ <br /> No. of compartments______ ----------- ---_ 5iz <br /> i <br /> from foundation.__��__._____._.Distance to nearest lot line_____._--_ <br /> Number of lines:---__- __ Length of each line---------Ca---------------Width of trench.___ _-_____- <br /> �, �,1 a ---------- -- 3 <br /> �- Type of filter material__-�C� --__-Depth of filter material---_-L_.'..._____.._Total length____.__._t_a-_- <br /> Seepage Pit: Distance to nearest well-------------_---------Distance from foundation-------------------.Distance to nearest lot line----------------- 9 <br /> ❑ Number of pits-----=.I ------------Lining material-----------------------Size: Diameter-----------------------Depth..------------------------------- <br /> F �+ f <br /> Cesspool: Distance from nearest wel!...............__Distance from foundation....._.---------._Lining <br /> ❑ material-.-.__...__---..--------____--_---_-- <br /> ` . <br /> D <br /> Size: Diameter.._._ -----------------------------Depth----- -- ------------------ ----------------___-Li uid Ca acitY- - ------------ -------_ <br /> . <br /> Privy: Distance from n arest;well---_____-----------------------------------------Distance from nearest building------------------------------ <br /> ..._---. + <br /> ❑ Distance to nearest lot line----- ------------- ------ --'-----�---� ---------------------------------- - - - <br /> -------------------------------- - <br /> Remodeling and/or repairing (describe): <br /> t-------------------------------------------___.-----__-_---__.---_----_,___v---_:__________.._________-_____-- __-_____..___.__.__________ <br /> _----_ <br /> y <br /> _____________________________________�,. <br /> ! 14 ' <br /> ------------------------------------------------------------------------------ f___-____.____------_---__._-_______.__________.__:_...___-__ ______...___.-__ <br /> I hereby certify that I have prepared this application and that the work w 1 be done in accordance with San Joaquin County <br /> ordinances, ate la , and rules and regulations of the San Joaquin Local Health District. " ! <br /> f -- ° ' - --------- --- "-----":._._....Owner and/or Contractor <br /> (Signed]' - ( I / ) <br /> i <br /> ------ ------- ----------- ---------- ---------- <br /> B i Ti+le <br /> ---------•----------------------- ---- <br /> (Plot pla showing size of lot, location of system in relation to wells, buildings, etc., can be! laced on revers side). <br /> t t <br /> (' F DEPARTMENT USE ONLY # 1 <br /> APPLICATION ACCEPTED BY---- ---- DATE_. _____# " -. - - <br /> REVIEWEDBY---------- ------------- -----------k------- -------- --------- ---------------------------------- `DATE <br /> BUILDINGPERMIT ISSUED--------------------------------- -------- - ------------------------------- ---------------- DATE-------------- ----------------- ---- - -------------- I <br /> Alterations and/or recommendations:------- --------- -------------------------------------------- -------------------i--------------------- #--------------------- <br /> rt _ <br /> *. - <br /> - -_------------------- -----------•- ------------- <br /> ------------- ----- - <br /> ---------- ---------------------- --------------------------------- ------ <br /> I ------------------------------------- --------------------- ---------------------------------- ----------------- <br /> FINAL INSPECTION BY:------ .. ... r .... , Dae--- ------------------- <br /> ---------- <br /> SAN <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxeltan Ave. f 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California 4t Lodi,California Manteca,California Tracy,California <br />