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FOR OFFICE USE: , <br /> ------------------------------ ------------- APPLICATION FOR SANITATION PERMIT Permit No. . _ -1 <br /> - - -- - ------------------------ ...... (Complete-in Duplicate) i <br /> -------------------------------- This Permit Ex ires 1 Year From Date Issued Date Issued ..a_._._l <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 LOCAT ON--------�� � ------- ------ • - *---------------- <br /> Owner's Name - ------ -I;': 1 --------------------- Phone------------------------------------ <br /> Address-- U6..... h _ t _.. . ,� ---------------------------•--------------•------------- <br /> Contractor's Name-- �r Phone- <br /> Installation will serve: Residence 2"' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: Number of bedrooms __c:7 Number of baths __/_ Lot size _4Q_-X l._�Z)--.-----.__._.__--__-_ <br /> Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table,_d ft <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_. -..- _ J No ❑ New Construction: Yes ❑ No R' FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: C <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> e tic Tank: Distance from nearest well-----------------Distance from foundation-..---__._-..._--..Material _----_.-.--------_--_-..._.__----..._---_---. <br /> No. of compartments--------------------------Size-------------------- -----------Liquid depth--------- - ----- ------- Capacity----------------------- <br /> Disposal Field: Distance from nearest well_ d_.� Distance from foundation-_ __ + < <br /> �,�.._____._.Distance to nearest lot line_® ______. <br /> Number of lines--.,/--------.------------------Length of each line--------- --- Width of trench..._ 1'A�, <br /> Type of filter mate ria l-Sr-_7P4-'_Depth of filter material----.-/ _------.Total length----------�1Q------------------------ <br /> i / d <br /> Seepage Pit: Distance to nearest well./Q..0._......Distance from foundation---�r.__�..___._.Distan e to nearest lot line/S._-.... <br /> p J-...-.---.-.Linin material.- _. Size: Diameter.--_ __ <br /> Number of pits--- ../-- -- 9 `�-�� - --Qepth__._,P�-�-�-------------- <br /> Cesspool: <br /> -- - - ---- <br /> Cesspool: Distance from nearest well ----------------Distance from foundation------------.---- ..Lining material---------------------------.---._---. <br /> ❑ Size: Diameter- -- --------- --- ---- -----------Depth--------- -----------------------_----------------Liquid Capacity---------- ------ ---------gals. <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 /> 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. <br /> (Signed) �.P---- c - ----------- ------- -- (Owner and/or Contractor) <br /> Ic <br /> By: ` ... 4- ------------ --------- <br /> Y - - ------------(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- _._11). ------ - ------ ------------- ------------------ DATE...... �J <br /> REVIEWED BY--------------------------- ------ DATE--.-- ----------- <br /> BUILDING PERMIT ISSUED-------- - --------- -------------- ----------- --- ------- -- ...........-------------------.- DATE----------------------------- ------- <br /> Alterations and/or recommendations--- ------- --------------- - - -------- - - --------------------- --------------- •-----------•-------•-------•------------------------ <br /> ---------------------------------- ----- - ----- ----------- ---------------------------- --------- ------toe <br /> ---------------------- ------------------------------------------------------------------------ <br /> I/ <br /> ----------------------------------- -------------------------------------------------------------- --- <br /> -------------------- ------------- ...... .......I......................../---------------------------------------------------------- - - <br /> FINAL INSPECTION BY:..---�---.-- .`. ----------------------- Date_. .. .! .t'_ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi. California Manteca,California Tracy, California <br /> E.H.9 2M 1-67 Vanguard Press <br />