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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT Permit No. ........ ..... <br /> ------------- --------------------- ----------------- <br />----------- - ----------------- ------------ ---- ------ (Complete in Duplicate) t <br /> Data Issued <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 o. <br /> r � ---- --•- -----�----------- --• -- - - <br /> -------------------- 33--S--�----- <br /> JOB ADDRESSA --------- <br /> l a �--�----- <br /> Owner's Name --------- --- - - - <br /> - <br /> 7/ <br /> - -------- - ---------------------- -- Phone ------------- ------------ <br /> r = <br /> ---- ------------ -•---------- -------Address_....r's - Phone_y------c1 <br /> Contracto _ <br /> Installation will serve: Residence [!14partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _-/-_ Number of bedrooms Number of baths ----/ Lot size -----------------._1.6--- <br /> i F ' <br /> Water Supply: Public system �ommunity system E] Private M. Depth to Water'Table 'i� _ ft. <br /> I <br /> Character of soil to a depth of 3 feet: Sand E] Gravel El Sandi Loam.❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> > ' <br /> Previous Application Made: (If yes,date--------------------) No New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ <br /> I <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Tank: Distance from nearest well-----------------Distance from foundation----_--_----r_--_- Material------_-----...--_----.---_-__----..-.-..--___. <br /> No. of compartments-------------------- ----Size-----•--------------------------Liquid depth------------ -- ----------Capacity--------- . <br /> Disposal iold: Distance from nearest well_ .Distance from foundation_..� --------Distance to nearest lot <br /> line_. ,____._._.- <br /> �/ Number of lines_: -----:/---------- -- --------Length of each line------.___f�_ to-._--....Width of french.________-y--- ._.____._ <br /> Type of filter material_:___S___Rar_k_Depth of filter material___-_ __ _��.-Total length-.-._--_-_--_-_-_1,_.d_�----;---.- <br /> 1 € __=___.Distance to nearest Iofi line__._--._----. <br /> Seepage P Distance•to nearest wet Q-----_DistanF <br /> _"Nom foundation__. <br /> Number of pits---.'-1--------------Lining rrraterial� OL/[�-----.Size: Diameter-_33----_------ <br /> i <br /> - -__Depth----t7�_S�_______-.------- � <br /> Cesspool: Distance from nearest well_ _____..__-__Distance from foundation....-----_--------.Lining material------------------------------------- <br /> . <br /> ❑ Size: Diameter-- --- ------- ----------- ------------Depth------------- ------------------- ----------Liquid Capacity- -------------------------gals. <br /> Privy: Distance from nearest well.--_-_-------.-#------------ --'----_-..._._-Distance from nearest building---------------------------------.-.------ <br /> ❑ Distance to nearest lot line------------------------ ------•-----------------------------------------° ----------------------------------------------- l <br /> " t -------------- l <br /> Remodeling and/or repairing (describe)-- ------------- - ----------- ----------- -------------------------• --------•--------- -------------------------- - + <br /> C --- <br /> --------------------------------------------------------------------------------- <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. S laws, and rules d re ations of the San J aquin Local Health District. <br /> (Signed) ---------- - Oner and/or Contractor) <br /> ---------- ------ <br /> Ti+I --------------- <br /> (Plot plan, showing size of lot, location o system in relation to wells, Ings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCI~PTED BY _ ._ . DATE------ ^" -�b - -_ <br /> --- -------- ----- <br /> REVIEWEDBY---------------------------`=---------I------- ------------------------------- ------------------- ---------------------- ---- DATE-------- <br /> I - --------- ----------- DATE------------------------------------------------------------- <br /> BUILDENG PERMIT ISSUI"D______________`:.--__ _ - - � <br /> Altera+ions and/or recommendations:---Vim ._. _ _- 'gyp ----- -------------------------------------------------------------------------------- <br /> ------ ------- - ----------------- -----•----------------------------- ------ ---------- ---------------- --------•----------------- <br /> F ------------------------------------------------------------------------------'------------------- <br /> ---------- -- <br /> --------------- <br /> I --------------------- ------- ------- ------------ -----------I-------- <br /> f <br /> FINAL INSPECTION BY.... . _ �---------- ------ <br /> ----------- Dat 1� ------ ------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. ; 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.FXD. <br /> t <br />