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r-ul< UrFICE USE: l <br /> �,,iv ---------- -- <br /> u APPLICATION FOR SANITATION PERMIT Permit No. ----­---------- <br /> --- --- ------------- ------- -- ---------------- (Complete in Duplicate) <br /> - This Permit Expires 1 Year From Date Issued Date Issued __ <br /> r> 1�3- lsO-a! <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construc and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. °' <br /> LZ <br /> JOB ADDRESS AND L CCATIO /.e f i <br /> Owner's NameL&�i� fr' ltrl-��.'`---------------.-------------- oned L� <br /> Ph <br /> Address---------------`�6 --- , - - 1-- <br /> --------------------•---------•-------------------- <br /> Contractor's Name---- 7 •----------------------------------- Phone------------•--------- <br /> . ,,��-���-------- •--��--.'-=---��-------------------- ----------- ------------ <br /> Installation will serve: Residence R Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: --I- Number of bedr'0oms.?-- Number of baths _I-__ Lot size _ ' <br /> --- -------------------------- <br /> -- _ <br /> ---- <br /> Water Supply: Public system Q Community system ❑ Private R`_`6`epth to Water Table ftp <br /> Character of soil to a depth of 3 feet: Sand Gravel Sand m Clay Loam Clay Adobe i <br /> p ❑ ❑ Y ❑ Y ❑ Y ❑ ardpan ❑ . <br /> Previous Application Made: (If yes,date___________ ________) -No New Construction: Yes ❑• No P��FHA/VA: Yes ❑ No Zi <br /> TYPE .OF INSTALLATION AND.SPECIFICATIONS: -� <br /> (No septic"tank�or cesspool permitted if public sewer is available within 200 feet.) ]l <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Maferial__----------__-_-_--.--__--------__.-.- <br /> /� / •o No. of compartments-------------------- Size------------------- ------ ------Liquid depth_-------------------- -Capacity----------------- <br /> Disposal <br /> --Disposal Field: Distance from nearest well----------- ----Distance from foundation------..---.--------Distance to nearest lot line----------------- <br /> m <br /> Number of lines Length of each line- ----------------------- Width of trench. - t <br /> ----- <br /> Type of filter material------_-----------------Depth of filter material__--.--_----_.. --.Total length_-.-.--- $ ` <br /> ` - ---------------------- <br /> Seepage Pit: ; Distance to nearest well-_ Distance frw foundation---�< _-----------Distance to nearest lot line_.---- <br /> ®�' Humber of pits._9Z------------Lining material_--Size: Diameter_ "._.- Dep ------___----------_1- <br /> s� <br /> Cesspool: Distance from nearest well-----------------Distance from foundation.- -----------------Lining material-.__-----_---_____-----.--___------ <br /> ❑ Size: Diameter--------------------------------------De th-------------------------------------------------- Li uid Capacity-4 r� - G p Y ---------•-------- ----•-gals,--� <br /> Privy: Distance from nearest well ------------------------------------------------Distance from nearest building.___---------__-_-----__-.----- <br /> ❑ Distance to nearest lot line-- -- -- - --- ------------------------------------------------------- --------------------------------------- f <br /> , <br /> Remodeling and/or repairing (describe):------- -- -------------------� P � G ---------- ------------ <br /> ' ' <br /> ----------•---------•---------------• ------------------------- ----------------------- ------------------------------------------------------- ----------------------------_ <br /> i <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 /> --------------- --- <br /> (Signed).- C! � � s � <br /> ------ ------ - ---- ------ ----------------------------- or Contract <br /> SY:----------------------------------------------------------- ------------------------ Title <br /> (Plot plan, showing size of lot, ]location of m in relation to wells, buildings, etc., can be placed on reverse side), <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------------------------- --------------------------- DATE------------- - ----f <br /> ----------- <br /> REVIEWED BY. ---- -- ------------------------------------------------------------------------------ DATE <br /> -- ------------- - ----------------------------- <br /> BUILDING PERMIT ISSUED------•------------------------------------- -- - / DATE <br /> Alterations and/or recommendations: ' - 1� ` /' ` - <br /> f -•----------------------------------- -------------------------------------- ---------------------- -----------------•------------- ---------------------------------•-------------------------------•------------------- <br /> --------- ------------------------------------------------------------------- <br /> ------------- ------------------------------------------------------------------------- -------------------------------------------------- --------------- -------------- <br /> FINAL INSPECTION BY:-------.......... --------------- *, # Date------- - (/ <br /> ------------------------------ <br /> `'SAN JOAQUiN LOCAL HEALTH'DISTRICT <br /> 1601 E.Hazellon Ave. '300 West Oak Street 724 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> o ' F.P.CO. <br /> t. <br />