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FOR OFFICE USE: <br /> --------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. ._r/P. �1 <br /> ------------------- ------------------_-- _-- -------- (Complete-in Duplicate) <br /> This Permit Expires ] Year From Date Issued Date Issued _p -_ <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 A D LOCATION_.2- -7/. /C.(. ' e --------------------------•-- •�--------------------------------------------------•------------ i <br /> Owner's Nam ���flIr <br /> - -- •----------------•------- Phone------------------------------_.---- <br /> Address-------- s....Q <br /> Contractor's Name --_-----� -- ----------------------------------- ------- ------------------------------------------ Phone------ --------•--•---•----------- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [] Other ❑ <br /> Number of living units: __ �_._ Number of bedrooms _. Number of baths.tr_.... Lot size __�V 'A <br /> .__-___________________________ k <br /> Water Supply: Public system Community system j] 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,dot e_................ ] No Ej� New Construction: Yes ❑ No [2�' FHA/VA: Yes ❑ No <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----- <br /> Distance from foundation/R------------Material --- <br /> No'. <br /> -No. of compartments_..___-------------Size------- _ _ J-x._ -Liquid de th__....F� ....... ........Capacity., ZDU U <br /> Disposal Fiel • Distance from nearest well----.............Distance from foundation------------------- Distance to nearest lot line----------------- <br /> fNumber of lines.----- ----------- ------Length of each line------------- ---------------Width of trench----------------------------------- <br /> Type of filter material________________________Depth of filter material------------------__-_-Total length' <br /> _.__.------ --- <br /> __- <br /> Seepage ht: Distance to nearest well__--------.-----------Distance from foundation--------------------Distance to <br /> ❑ Number of pits.--___-. ------------Lining material---------------------- Size: Diameter---------------.----.Depth_.-.----.-.---------------------- <br /> Cesspool: 'Distance from nearest well ------------- Distance from foundation________________ Lining material__._.______________.___________..__. <br /> ❑ Size: Diameter- -- ----- ----- --------------- Depth----- --------- ------------------ ------ - - ------Liquid Capacity,-,---------- --------------gals, w <br /> Privy: Distance from nearest well_______________________________________________-Distance from nearest building__.___._____.---------------------------- 1. <br /> ❑ Distance to nearest ,lot line---------- -------------------- - / <br /> r� <br /> Remo eling and/or repairing (descriEJe)---------- .__ c 1� <br /> "a --t <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 law paa d rules an re ulationof the San .loo uin Local Health District.Si ned ---------- ---� -----._...----------- - - (Owner and/or Contractor) r <br /> ( 9 )----------------- <br /> By: --- ---------------- -----------------to wells .-----------------------_Title ! <br /> (Plot plan, showing size of lot, location o <br /> g f system in relation , buildings, etc., can be placed on reverse side). ) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.-..w ----------------------------------------------------------------------------- DATE_2 Z 6 <br /> REVIEWED BY---------------------------------------- <br /> - -------------------------------------- --- ------ DATE-----------•------------------------ --------------- <br /> BUILDINGPERMIT ISSUED------ -------------- ------------------------------------------------------------- DATE------ ---------------------------------------- <br /> Alterations and/or recommendations:-------- - -- - -------•----------------------------------------------------------------------- <br /> ------------ --------------------------------------------------------- --------- -------- ...............�----------------------- - <br /> . <br /> FINAL INSPECTION BY:...--- -- --------------------- ---------- ------------- Date-- ----- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Na:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> E.H.9 2M 1.67 vanguard Press <br />