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FOR OFFICE USE: <br /> ------------------------------ - - - ------- ---- ------- <br /> ----- APPLICATION FOR SANITATION PERMIT Permit No. <br /> ----------------------------------------------I -------- (Complete in Duplicate) Date Issued <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. <br /> JOB ADDRESS AN CATION _ -_ _ ___ ______________ __l------ <br /> ---------- <br /> Owner's <br /> - <br /> Owner's Name -- ----- Phone_ > 35 <br /> --------------------------------- <br /> Address 1+4-3 �-�- �-- <br /> Contractor's Name � <br /> -- <br /> Phone----------------------------- <br /> Installation will-serve: Residence [I/Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _ ___ Number of bedrooms__. Number f baths __ __ Lot size -___.___.__________..____ <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 Ir <br /> Previous Application Made: {If yes,date------------- ---- -} No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: \f <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �T <br /> Septic Tank: Distance from nearest weN-----------------Distance from foundation------------ Material_________________________________________________ <br /> ❑ No. of compartments--------------------------Size----------------------------=---Liquid depth--------------------------Capacity----------------------- <br /> Disposal Field: Distance from nearest well-.----------------Distance from foundation____________________Distance to nearest lot line----------------- <br /> El Number of lines-----------------------------------Length of each line.-.=f-------------------------Width of trench------------- ------ <br /> Type of filter material-------------- Depth of filter material------------------------ length------------------------------------------ <br /> See pa Pit: Disfance to nearest well__A!p.._______Distance from foundation--/ ...........Distance to nearest lot line__- <br /> ____._ <br /> / <br /> Number of pits..... -_____.._.---Lining materiaL �_12_. Size: Diameter------�3._.,____Deptn__�._s____-_ ___ <br /> Cesspool: Distance from nearest well-----_------___Distance from foundation--------------------Lining material-----------._______.__.___----_---- <br /> ❑ Size: Diameter------------ -------------------------Depth---------------------------------- -----------------Liquid Capacity------------- --------------gals. <br /> Privy: Distance from nearest well____---------------------__---------------------__Distance from nearest building----------__ _-___------------------.._. <br /> ❑ Distance to nearest lot line----------------------------------------------------------------------- --------------------`------------------------------ - ` <br /> Remodeling and/or repairing (describe)________________________ ____ <br /> •-- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•------------------- - -- ------ -- <br /> I hereby certify that I have prepared this application and that the work will lle done in accordance with San Joaquin County <br /> ordinances, State I and rules and regulations of the San Joaquin Local Health District. <br /> (Signed) ---- ---------------------- 1- ------ --- ---------------- - ------ ---- and/or Contractor <br /> gY� = (Title) :._=----------- <br /> ----(j4 <br /> (Plot plan, showing size of lot, location of sy �fiionjo wells, buifdings,•etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY...- ---------------------------------------- DATE---- <br /> REVIEWEDBY------------------------------ ----- ----------------------------------------------------------------=---------- ------------ DATE--------------------------------------------- •----------- ; <br /> BUILDINGPERMIT ISSUED------------------ --------------- ------------------------------------------------------------------- DATE---------------------------- -- -------- -------------------- <br /> Alterations and/or recommendations:------------------------------------------------------------------------------------------------------------------- <br /> -------•--------------------------------------------------- ------------------------------------------------------------------------------------------------------•------------------------------------------------------ <br /> ----------------------------------------------------------------------------------------- --------------- ------------------------------------- <br /> ----------------------­------- <br /> -----------------------------------------------------------•------- -------------------------------- ------------- ------------ ------- --------------------------------------------------------------------------------- ---------------------------------- <br /> FINAL INSPECTION BY:.... .w- /fir?"'? ------------ Date.------------I-----........ ----------------------- ---------------------- <br /> i <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT a <br /> 1601 E.Naselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton, California Lodi,California Manteca,California Tracy, California <br /> Q � <br />