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FOR OFFICE USE: - -�- <br /> ---- -- ------------------------- <br /> --------- ----------. ----------------- ----------- - APPLICATION FOR::SANITATION PERMIT Permit No. <br /> - -- ------------- -- ----------------------- ------ - (Complete-in Duplicate) <br /> ------------ ----- --- --- I This Permit Expires 1 Year From Date Issued 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 Couptyf9g gi nct N <br /> JOB ADDRESS AND LOCATION—_ ________ __ �R�►« </ . <br /> j] ----------------------- -- <br /> Owner's Name-- = Phone <br /> Address ! � t� ^-'----- �---------- <br /> ----------------------------------------------------•------- ----------------- -------------------.._..- <br /> Contractor's' Name-- ••---� - - '. _._ >_ _ <br /> ----------------- ------- ----------------------------------------------- Phone------2_Tg.;42._ <br /> ----------- <br /> Installation will serve: Residence ( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [] Other ❑ <br /> Number of living units: -. -_ Number of bedrooms -.3__ Number of baths--Z Lot size --.77_ �"� ? <br /> Water Supply: Public system 19 Community system E] Private ❑ Depth to Water Table ------ - .ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam DZ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: 'I I f yes,date_................. ) No�k New Construction: Yes • No ❑ FHANA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ' <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distancexfrom nearest well.&/A --__Distance from foundation IV---•-t -----Material <br /> l <br /> -- -------- �-----� <br /> -- , <br /> �. No, of compartments...____. Size #{>'_�-_-_ ---Liquid depth------- e- __....-_Capacity_ Q.�' <br /> ---` t <br /> Disposal Field: Distance,from nearest well ------Distance from foundation-_..----------------Distance to nearest lot line-----_----- <br /> ❑ Number of lines.--------------------- ..-.-_Length of each line------------------------------Width of trench- . <br /> Type of filter material------------------ <br /> -------Depth of filter material--_..-----------------Total length--------------------------_---------- <br /> Seepage Pit: Distance to nearest well.../6_�dP_L,­`Distancekom foundation__,/,e__r-__-__.Distance to nearest lot line---c_e_.� _ <br /> Number of pits... ----/----__----__Lining material-- ��.- Size: DiamX6 <br /> eter-_;Ir4_--Depth---j_c�C-/---- --------------- l <br /> Cesspool: Distance from nearest well ----------------Distance from foundation_-.- ----..Lining material-.__.-------------_____---_-_------. <br /> ❑ r Size: Diameter- __ <br /> ----- ---------- -Depth-------- -------- ------ ---------------------Liquid CapacifiY----------------------------gals, <br /> --- -------------------gals. <br /> Privy: Distance from nearest well--------------- --- _--------_-------------Distance from nearest building-------------._------------------- - ------ <br /> Cl Distance to nearest lot line__________ I <br /> - ----------------------------------------- ------ <br /> Remodeling and/or repairing (describe)______________________ 4 <br /> E <br /> t --------------------------------------------------------------- ----------- -------------------- <br /> - ----------------------------------------------- - " <br /> ---------------------------------- ---------------•----------------- -----------------------------------------------------=------•--------------------------------------------------------------------------- <br /> I hereby cer ' y Wa I have epared this ap lication and that the work will be done in accordance with San Joaquin County <br /> ordinances, St a S." nd rul a ul he Lean Joa ocal Health District. <br /> (Si ned - - <br /> 9 } ------------ - -- - -- ..-� <br /> --- --•------ .--- •- ---•.--.-- --- ------ ---� -- --- - - --------------------- =--- --------------(Owner and/or Contractor) <br /> By-------------------- <br /> - _. <br /> ----------------- --------------------- -------------------- ------------------(Title) --- <br /> (Plot plan, showing size of lot, location of system in relation to wells,'buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- ---- ----- - - DATE <br /> -- -_ <br /> REVIEWEDBY---------------------------------- --------- ---------- ----- DATE---- <br /> --------------------------------- <br /> BUILDING PERMIT ISSUED-------- ­­------------ ----- - -- ----- ---------- DATE <br /> Alterations and/or recommendations:._............... <br /> -----------•-•------------------------------------------- ---------- ; <br /> ---------- ------ --------------------•---------------------------------- - - <br /> - - <br /> --- -------------- • - ----------- ------- <br /> FINAL INSPECTION - -- �- - - -- --------- Date_ —f <br /> +y J -SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave, , ' <br /> 300 Wes!Oak Street 124 Sycamore Street <br /> 20$ West 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press 1 <br />