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r FOR OFFICE USE: <br /> --------------------------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete-in Duplicate) Date Issued Z��--/,-/­i;�7 <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. <br /> JOB ADDRESS AND LOCATION--- .. ../-�_.----- �- r-//� { �' -------« ----�------------------------ <br /> Owner's Name-All-,....-- 1' r ¢,,e�- ------ --------- Phone ------------ <br /> Address: y '�- .!... -------•---•- ---------- ---------------------------------- <br /> Contractor'sName.- ,nir .er --•----------------- ---•----------- --.._. Phone------------------------------------ <br /> ------------------- ------- ------------------------ <br /> Installation will serve: Residence D] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: .----- Number of bedrooms ..a... Number of baths J.... Lot size -._ .--..--.__-___._------..._._-. <br /> Water Supply: Public system ❑ Community system ElPrivate [� Depth to Water Table 3-57'ft <br /> Character of sail to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam �j Clay Loam ❑ Clay ❑ Adobe❑ Hardpan E❑ <br /> Previous Application Made: (If yes,date-.__..__._.,..._--- I No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> s Septic Tank: Distance from nearest well.................Distance from foundation--------.-----------Material _.----------.---- ------------------...__--.... <br /> ❑ No. of compartments.------ - ---Size--------------------- -----------Liquid depth--------- ------ ---Capacity---------- ------------ <br /> Disposal Field: Distance from nearest well. -------Distance from foundation-.- .......Distance to nearest lot line.-— ------- <br /> �] Number of lines----1--------•------------ 'r' <br /> :....--Length of each line.-..2�------------------Width of trench---,�--�-------------------.--•-- <br /> �q, p Type of filter material-��{:.- -.--Depth of filter material----./.- '........Total length..�y--I--------------_------------ <br /> `�pat�e{pit: Distance to nearest well--_-i_U...........Distance from f undation__rQ_'*...--- Distance to nearest lot line._(_ V_.--_-- <br /> Number of pits--- ...Lining material ...- Size: ter..t1-...1 4. Dept h.... ''-�--- -------------- <br /> Cesspool: Distance from nearest well ----------------Distance from foundation................. ..Lining material------------------------------------- <br /> Size: Diameter- __ ._._.___ .__ <br /> ❑ - --- ------------Depth----- ---------------------------------------------Liquid Capacity-- --------------------•---gals. <br /> } ..Distance from nearest buildin <br /> Privy: Distance from nearest well---- -- ------------------------- - ------- b0ding_--------------------------------------- <br /> ❑ Distance to nearest lot line ................ ------------ -•-------------------------------------------------------------------------------------------- <br /> Remodelingand/or repairing (describe)--------- -----•-------------.......-------------•---•-•-•---------------------------------------•------ ------------------------------------------- <br /> ------------- <br /> ------------- ------------------------------•-------•-------------------------------------------------------------- ----------------------------------------------------------------------- -----------------------------•------------------------- ---- <br /> ---------- ------ ---------•------------------------------------------------------------------------------------------------------------------------------------ <br /> I hereby certify that I 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. a Ap <br /> x <br /> (Signed)------- - ----(Owner and/or Contractor) <br /> �A <br /> BY: ----------- ---------------------------------- -- ------------------------------(Title)---------- ------ —----- --------------- .....--.... <br /> 1 (Plot plan, showing size of is , iocation of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> i <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - ------ ----- --------------------------- DATE- ---- <br /> REVIEWEDBY------ ------------------ ------------------- -_--------------------------- ------------------------------------------------ DATE----------------- ----------- ----------------------------- <br /> BUILDINGPERMIT ISSUED-------- ------------------------------------------------------- ------------------------------------- DATE-------------------- <br /> Alterations and/or recommendations:. --------------------- .................... - - • ----------- - --------------------------------------------------- ------------------- -•----•---- <br /> -------------------------- --- --------------------------------------------------- --------------------------------------------------- ----- <br /> -----•----------- ---------------------- -------_.----- ------- ------------------------ ----------------- ------------------------------------------------------------------ ----------- - ° ----------------- <br /> t ----------------- .................._._. ....... . . ------ .-- -------------------------- ---------------------------•-------- -..------------------------- ------------------------------ ------------•--- <br /> [ <br /> FINAL INSPECTION BYT ... _. - Date.. ` ------------------------------------ <br /> SAN <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1401 E.Harellon Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street <br /> Sfocklon,California Lodi, California Manteca,California Tracy,California <br /> E.H.92M 1;67 Vanguard Press ,y = <br />