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FOR OFFICE USE: <br />------------------------------------------------------- <br />------------------------------------------ ------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. ••-Q`-�,q-- <br />----------- --------------------------------- -- (Complete in Duplicate) <br /> Date Issued _s�1;2.`..- <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. t <br /> JOB ADDRESS AND LOCATION ' --h--�----- ------------------------------- ---------------------------------------------------•----------- <br /> r <br /> Owner's Name--- -- - -r-••------- --------------•----------....----------•-------------------------------------------------------------------------------- <br /> -- Phone------------------------------------ <br /> Address------------- <br /> -----------------------------------Address------------- 7 --------------------------------------------- -------------------------- •-------------------------•-------••-----------------------------•---------.. <br /> Contractor's Name •— _.. ------------------------------------- -- Phone----------------------------------- <br /> Installation will serve: Residence ffI Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ___1-- Number of bedrooms __¢_._ Number of baths - - Lot size ____________________________________________________.__._ <br /> Water Supply: Public system 2--C Immunity system ❑ Private ❑ Depth to Water Tableil�`ft. <br /> Character of soil to a depth of 3 feet; Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Er'-Hardpan ❑ <br /> Previous Application Made: {1f yes,dote-__.__.------------) No New Construction: Yes­�No [ FHA/VA: Yes ❑ Noj[ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Sep c ank: Distance from nearest well-----------------Distance from foundation--------------------Material--------.____.__.___._____________...____.____. <br /> No. of com artments__________________________Size__________--.-. ____________-___Liquid de th---_._._------------------Capacity <br /> Disposal Field: f Distance from ne f <br /> p wrest well------------------Distance from foundation--------------------Distance to nearest lot line_________-______. <br /> �� Number of lines-- I-------------------------- Length of each line-----------.------------------.Width of trench---------------------- <br /> Type of filter material-------------------------Depth of filter material-----------------------Tota4 length---_-___________:____.._________________ <br /> Seepage Pit: Distance to nearest well.____r~___..._._Distance from foundation____1!!_..____..Distance to nearest lot iine'r________._ <br /> Number of pits---::}__.___.___Lining material___ (k -----Size: Diameter. .--____. _ De th___ <br /> -- - p --------------- <br /> CCesspool: Distance from nearest well-----------------Distance from foundation____..._.ii <br /> esspool: material____-_ ______________________ ►� <br /> Size: Diameter--- l--------------------------------De th--------------- -----------------------------------Liquid Capacity gals. <br /> Privy: Distance from nearest well--------_-----------------------------------------Distance from nearest building___.-___._____________________._.._. i <br /> ❑ Distance to nearest lot line---------------------------------------------------------------••------'--------------------------------------------------------- ------- <br /> Remodelingand/or repairing (describe)----------------------------------------- ------------------------------------------------------•------------------------------------•­----------------- <br /> ------------------------------------------------------- <br /> .. <br /> i <br /> ------------------------------------- --------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------- - - <br /> I <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 I �ruleIations of the San Joaquin Local Health District. <br /> --------- ------ Owner and/or Contractor <br /> (Signed) - --------- ------- ( / ) <br /> BY=----------------------------•---------------------------------------------- -- - -----J---------------------------------- (Tule)- ------ ----- ---- ------- - ------------- - ------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> t <br /> FOR DEPARTMENT USE ONLY f <br /> APPLICATION ACCEPTED BY_. ._ ,.+�R�___ - ---------------- <br /> ------------------------------ DATE -"Z c� ---------- ---------------- <br /> REVIEWEDBY----- ----------------------------- --------------------- ------------------------------------------•--•- ------------------ DATE----------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED--------------------------------------------- ----------------------------k------------------------ DATE------------------------------------------------------------- <br /> Alterationsand/or recommendations----------------------------------------------------------•--------------------•----------------------•------------------ ----------------------------------- <br /> I <br /> ------------------------------------------------------------- <br /> ---------- <br /> l <br /> I <br /> E <br /> -� - <br /> FINAL INSPECTION BY:_. __._. -.- --- <br /> _. --------------- ----- Date - --- ------- --- - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.F.0 O. <br />