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FOR OFFICE USE: , <br /> 30 <br /> APPLICATION FOR SANITATION PERMIT Permit No. ,:.2- <br /> --------- <br /> --------- ---------- - - ----- --------- (Complete-in Duplicate) <br /> ... Date Issued <br /> ............. ...__ . This Permit Expires I Year From Date Issued <br /> _ <br /> 1 1-60 <br /> Application is hereby made to the San Joaquin Local Health strict for a perm' onstruct an install the work erein describ <br /> This application is made in compliance punty Ord, nce o. 5 9 <br /> . <br /> JOB ADDRESS AN LOCATIO --- ------ ----•--- - ---- -- - ---- --- --------- - / / • <br /> Owner's Na --- Phone _- fes-- <br /> ----------- <br /> ------------------------ - <br /> Address------------------- --' --- -- ---OX---------y ---------5 �--------- •----- <br /> Contractor's Name----------------- -----------R ---- --SR------// C---'--------- ------- -- -------------------------------------------- Phonel <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court p Motel p Other ❑ *� <br /> q <br /> Number of living units: _�___._ Number of bedrooms _Lr Number of baths---I... Lot size _______________ W <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Ciay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: (If yes,date_.................. ) NoX—New Construction: Yes ❑ No�-FHA/VA: Yes ❑ No_j< <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well_________________Distance from foundation-------------------Material -----_------___-----.__----________-._.__--_-_. <br /> ❑eiaS`(YA* No. of compartments--------------------------Size------------------ Liquid depth.-------- ------- ------- Capacity------------------- <br /> r : <br /> Disposal Field: Distance from near st well_ DA___._.Distance from foundation___. .- Distance to nearest lot line-4-0'r <br /> ...... <br /> Number of lines__(/ Length of each line__ i�___._.Width of trench__Z-4 -T_______________ <br /> Type of filter material__ ___ __ R. Depth of filter material._._ - ------Total length----------------------------------- <br /> Seepage <br /> --- --.--3_S_!__.________ <br /> r � � <br /> See a e Pit: Distance to nearest well-/O-IS - Distance m f ndation__ <br /> p g -- __ . .-__ .3Q_______.Distan�e to nearest lot line_�'p___._-_ <br /> Number of pits._( Q[f_ _Lining material____ Size: Diameter_--s?- f__...___Depth___.�L _*-_____________ 10 <br /> Cesspool: Distance from nearest well ________________Distance from foundation__________________Lining material----------------------------- <br /> [❑ Size: Diameter- -- ------ --- - - --- ------ --Depth-------------------------------------- Liquid Capacity. ---------- --------------gal <br /> Privy: Distance from nearest well________________________________________________Distance from nearest building_________-________.___.____________---_. <br /> ❑ Distance to nearest lot line -------------- - -------- --- ------------------- r ----------------- <br /> ----------------- <br /> Remodeling and/or repairing <br /> -------------- ---------------------------------------------------------_­----------------------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certifygdrule <br /> repared this application and that work will be done in accordance with San Joaquin County <br /> ordinances, State lawnd regulatio of the San Joa n Local Health District. <br /> (Signed)---------------------- -.._ .. .-- ---- ---------- ------- ----- Owner and/or Contractor) <br /> By: S..�i�tr ------------- ----- (Ti+le) `�+ ------- <br /> - <br /> - <br /> (Plot plan, showing size of lot, location of system in re ation to wells, buildings, etc., can be placed on reverse side). <br /> R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- ------------------------ - ------------ DATE.-__h .-------------- <br /> - ---------------- <br /> ------ - ----- ---REVIEWED BY DATE <br /> BUILDING PERMIT ISSUED-------- -- ---------------------------------------------------------- - - -- ------------- DATE--------------------- <br /> - -- - -- ----- --------------------- -- <br /> Alterations and/or recommenda+ions:--------- - -- --- -------- -------- ----------------- ------------------------------------------------------------ ----- <br /> --------------I--------------------- <br /> --- <br /> -- -------------------------------- -- <br /> 1� � ------.... ------------- <br /> ---------- ....... ---------- ---------------------------------------------------------- --•- ------------------------ ------------------------ ----------- ---- ----------- ---------------- <br /> ------------------------ --------.... <br /> .----- .... ............ ------------------------------------------ -------------------- <br /> FINAL INSPECTION BY:...---- rfL `` `�--------- ------- Date---------- <br /> / � ------ <br /> AN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.1lazeltan Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street <br /> Stockton,California Lodi. California Manteca, California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />