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FOl2 OFFICE USE: <br /> ------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No, .................. <br /> .... -------------- (Comple+e•in Duplicate) <br /> ..-- ---- . ` This Permit Expires 1 Year From Date Issued 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. 544 <br /> 9 ` <br /> JOB ADDRESS AND LOCATION------4-_- -0-- --- <br /> . = ` -----Owner's Name------ -- -----•------- ��----- --- Phone------ -----=---•-------•------•---- <br /> Address._.. _ -----'... ----------------- -- -------- --------------------------------------------------------------------- = <br /> Contractor's NameZ _ - .-- --- ------- ---------- ---------- --------------- <br /> Installation will serve: Residence P Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _l___:Number of bedrooms ---�Q—Number of baths _- J Lot size ----- --. � ,. Xvf <br /> Water Supply: Public system E] Community system E] Private Depth to Water Table ------ _ ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy loam [!Er Clay Loam ❑ Clay [ Adobe ❑ Hardpan ❑ ` <br /> Previous Application'Made: {Ifyes,date----------- -.-_-- 1 No [a" New Construction: Yes ❑ No [ FHA/VA: Yes ❑ No <br /> - <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 /> ❑ No. of compartments------------------------Size-------------=------------- ---Liquid depth------- ...... .------ Capacity----------------------- <br /> 4lineV, <br /> pisposal Field: Distance from nearest well.-zj_Q...._Distance from foundation. /�...�__..Distance to nearest lot _t�.._--_-- <br /> Number of lines--.-----_ Length of each line-- -----t0--------------Width of trench.___ 61 V__ <br /> (R ' 7----- ------- <br /> Type of filter materiaV ;,z 4- Z. Depth of filter material-:./e-__:......Total length_-_-___ � ______________________ <br /> I 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 ----------------Distance from foundation---------- ------ ..Lining material_------_---------._..-____.__----_. <br /> ❑ Size: Diameter- -- --------- -- -- ----------------Depth-.------------------: ------- -- ---­------------- Capacity----------------------------gals. <br /> Privy: Distance from nearest well---------------------------__-__-__----_.-....--Distance from nearest building------------------------------------------ <br /> 0 Distance to nearest lot line ------ ------------ ------------------------------------------------------------------- - ------------------------------------------- - <br /> Remodeling and/or repairing (describe):-----. -..-- T -------------------------------------------------- <br /> ---------------------------------------------------- -------------- - -- ------------------------------------------------------------------ --- ------------------------------------------------------ ------ <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) --- --- -- -..-�------- ------------------------------ -----(Owner and/or Contractor) <br /> By:. --------------- ------------------------------------(Title)----------------- ----------- - ------ - ......----- <br /> (Plot plan, showing size of lot,.location system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> I APPLICATION ACCEPTED BYR _- --------------------- DATES <br /> REVIEWEDBY----------------- -------------------------- ----------------------- ---- - --------------------------------------- E-------- ----------- -•---- ............ <br /> .BUILDING PERMIT ISSUED-------------------------------- _ - - --------------- ------------------ - ----------------- <br /> .` _ "' 1 ' <br /> -------- ------- ----- <br /> Alterations and/or recommendations:----- -------_--- ------ - - <br /> ---- --- ------------------------------ ------------------------------------- <br /> - ---------------------- -1---------- .......... --1- --------------------------- - -I---------------------- ------------------------------- -- - ---------- -------...------------------------------------------- <br /> } ---------- ----------- ------ --------------- -------- -------------- ---------------------------------- ------- --------------- ---------- ---- ----------------------- <br /> ----------- --------- -- -------------------- - -- -------------------- - - ---------------------- ------------- ----- ............ ------ -------------------- -------- ----------------- <br /> 27 <br /> FINAL INSPECTION BY:C.--- - -------- . -- ----- ----------- ------ -- - Date -):`�-._�- .---- ----------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hoiellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street <br /> 1 Siucklan,California <br /> Lodi. California Manteca,California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br />