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FOR OFFICE USE: <br /> -------- --------- ---------- -------- ---- --- ------ <br /> APPLICATION FOR SANITATION PERMIT Permit No. ''-.-� �} <br /> --------------- ----------- -------- ---- -- (Complete-in Duplicate) <br /> _--.-._.. This Permit Expires 1 Year From Date Issued Date issued . -� �� <br /> r <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----- �1-�------`� . . .. r <br /> Owner's Name---------- -•----- Q ----,-te--t.. <br /> --------- Phone----------------------------------- <br /> Address-------- <br /> ------------------------------fya <br /> Address-------- - ------- •...... <br /> Contractor's Name.............f7 <br /> `� � --------------- ------- -- -------------------------------------- Phone-----..---------------------------. <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ /Trailer Court Motel ❑ Other ❑ <br /> Number of living units: Number of bedrooms - Number of baths-�-.. Lot size " -_--- ---------------------------------------.---------------__-___.- <br /> Water Supply: Public system E] Community system ElPrivate Depth to Water Table,?Q 'It. <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- --.r -- ) No � New Construction: Yes �No E] FNA/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 /> r <br /> Septic Tank: Distance from nearest well- _._.Distance from foundation. --.-.---- Maoiale '!`� .............. <br /> [� No. of compartments----X-----------------Size !�?AO—Liquid depth-' � Capale�Q.. <br /> city-- ... <br /> Disposal Field: Distance from nearest well- -----Distance from foundation---e* A9--------Distance to nearest lot line-m:�--------.-- <br /> [�� Number of lines-------- <br /> Length of each line-- __pe.` .-------...Width of trench_. _'e------------------------ <br /> ype of filter materialzi, Be . Depth of filter material___�'� __----.-.Total length_.�4<0--------------------------- <br /> Seepage Pit: Distance to nearest well............. <br /> .._--__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 founda+ion.........-------- - Lining materiaL._.----------------.------.---------. <br /> ❑ Size: Diameter- -- --------- ----- ----------------Depth-------------- ------------- ----------------------Liquid Capacity---------------------------- <br /> gals <br /> . <br /> Privy- Distance from nearest well _-------------------------------Distance from nearest building-..-.---....-------.------_--------___-_. <br /> ❑ Distance to nearest lot line ------_- ----------- -------------------------•-------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):....... ------ <br /> --------------------------------------------------------- -------------------- ---- ----------------------------------------------------------------------------- ------------------------------------------------- -- <br /> -------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------- --------------------------------------------------------- ----------•-------------------------------------------------------------------------------------------------------- --------------------- <br /> I hereby certify that 1 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 /> (Signed)-------------------------- i / -'` �� (mar Contractors <br /> By:-------------------------------- ------•--- -- . o ----------------------------------(Title}� ' <br /> (Plot plan, showing size of lot, locatio system in relation to wells, buildings, etc., can be placed on reverse side]. <br /> 0. FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- --------------- DATE-�_7,7 6_9------ - -- - - <br /> REVIEWED BY------------------ ------ ------------------- ._----------------------------------- -- - ------ ---------- - ---- ----- ------ DATE------------------------------------ <br /> ----------------------- <br /> BUILDING PERMIT ISSUED-------- -- -- --------------------------------------------------------------- ----------- --- ------ DA-TE------------------------------ ------ ---- <br /> ------------------ <br /> Alterations and/or recommendations--------------- - - -- ----- ----------- --------------------------------------------- - ------------------------------------------ <br /> - - --------------------- <br /> -------- --------- - --- --------- -------------------------------- -- -------------------------------------------------------------------------------- ---------- --------------------------- <br /> Date <br /> —FINAL INSPECTION BY---- - ---- --------- ------------- -- 7_60-- ©------ <br /> SAN <br /> - -- <br /> SAN - <br /> JOAQUIN LOCAL. HEALTH DISTRICT <br /> 1601 E.Hazeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi. California Manteca,California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br />