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FOR OFFICE USE: IVOrt4 <br /> ------------ <br /> ----------- ------NO <br /> ---------- ------- APPLICATION FOR SANITATION PERMIT Permit No.---_--- -- ----------- -----.---- (Complefe•in Duplicate)__________________ ____________.____.__...._.._.. This Permit Expires 1 Year From Date Issued <br /> 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. <br /> JOB ADDRESS AND +LOCATION-' 1. '- --_---„�� �f d7__ �3' ,�G -,/ ° .- ' � ._C/ <br /> .---- <br /> Owner's Name------eC't'� .. .-:..�- _ _ �---- - ----�-��- ----------------- ------- <br /> Address <br /> Phone '/ L <br /> ---- ---- <br /> .e7 - <br /> Addressp ..._.� ------- �•• l <br /> Contractor's Name al-_� =� _.�Q d'---------------------- ------- --------- --------------- ------- ------ Phone.----- ••-•----_ <br /> Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> d <br /> Number of living units: _/__ Number of bedrooms _/___ Number of baths_/'___ Lot size "A'-O,- "/— ----------------------------- <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 ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date_--- -- l No P— New Construction: Yes FT"�No ❑ m FHA/VA: Yes ❑ No R; + <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) j <br /> le _ <br /> Septic•Tank: Distance from nearest well-Ar_.-Q---"-Distance from founds ion%7 <br /> -------Material,�O ------------- C7 l <br /> No. of compartments...... .___.__.-_..�._.Size���...—;.���Liquid depth_�1�...,,. ----- Capacity. � --r-- ("-j <br /> I Disposal Field: Distance from nearest weILQ.___._Distance from foundation_. ,�}_.--._..Distance to nearest lot line__��__O--.---.. <br /> /� i i <br /> Number of lines.-----------------z Length of each line_. . __fc_..______._____.Wldth of trench_ --�.__.__.....__..____._.._ ` 1 <br /> s <br /> Type of filter materiae ..____Depth of filter material_-_ '}`..__.Tota! length__��-----._ <br /> Seepage Pit: Distance to nearest well-..,_.__-------------Distance from foundation------------------- Distance to nearest lot line_-____----.-..- <br /> ❑ Number of pits--- ------------------Lining material-------------- -- Size: Diameter.---------------- -----Depth----...---------------------.- -- <br /> Cesspool: Distance from nearest well ----- ----- from foundafiion----..----------- ..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-------------- ------- ---- ----------•-•--------------------- <br /> 1���-------- <br /> Remodeling and/or r pairin . (describe):------ _��� _- � ---- - - ---------• <br /> f� {� ` ---------------------------- - ------"------------------------.--------------if = �. <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) ,/ 0. -------------------------- --------------------- - ---( or Contractor) #� <br /> By:-------------------------------------------------------- -- - --- ---- -------------------------- -------- --- --- -- ----- <br /> (Plot plan, showing size of lot, location of st in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEP RTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------- --------- - - --- -- T DATE._-- *� �s <br /> ---- ---- ----- - --- - <br /> REVIEWEDBY---- ------------------- ------------------- ---------------------------------------------------- ------ --------- DATE----- <br /> - ---------- --------- ------------------------------ <br /> BUILDING PERMIT ISSUED-------- -- -------------------------------------- ----------------------------------- ------------ DATE_----------------------- _ <br /> 0 <br /> Alterations and/or recommendations----------- ­----------- ----------------- ------------------•-- -••---------------•---------• <br /> ------------------ <br /> ----------------------------------- <br /> ---------------- --- <br /> j <br /> -------------------- --------------- --------- ---- ------------------- ------ ----------- -- ------------------------------- ---------------------------- - ------.-- ---- ----- --.-I- -------------- a <br /> - -------------------------- <br /> FINAL INSPECTION - Date-- /� <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1641 E.Massillon Ave. 300 West Oak Street 124 Sycamore Street <br /> y 205 West 9Th Street <br /> Stockton,California ,nodi.California .. Manteca,California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press 4” <br /> I <br />