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FOR OFFICE US& <br /> ----- --------- ------- ----- <br /> ' ---- - ._ - APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------------------. .�-...-. ------ (Cornplete•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 AND LOCATION--... ----- ---------- (--------- <br /> - ---------------- <br /> Owner's Name y� ------------------------------- ------ - - --------------------- -------------------- Phone------------------------------------ <br /> Address . -------------------------------------•---•---•--------------------------------------------------- -------------------------------------------- <br /> Contractor's Name-----=--- - - ----�-- --r_-_-�_ ----------------------------------------------- Phone------.-----------------_. <br /> Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: J---- Number of bedrooms--3.- Numberzof baths---Z_Lot size <br /> Water Supply: Public system fQ—Community system ❑ Private❑ Depth to Water Table <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam �y ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date------------------- ) No New Construction: Yes No FHA/VA: Yes �o ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ` <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet, CC_ <br /> r <br /> Septic Tank: Distance from nearest well--- ----------Distance from foundation- .......Material ---__�`._ <br /> No. of compartments__-"��_- -----�--- q <br /> - - --Size--�.X�``Y. Liquid depth----- --- -- Capacity._�hit?�.��. W <br /> Disposal Fie#d: Distance from nearest well __ Distance from foundation-:'�_—...Distance to nearest lot line'_ <br /> Number of fines--_--- ..----._------_Length of each line-- ---------------------------Width of trench-...--_--_-__-------------_____.-__ <br /> Type of filter material-------------------- - --Depth of filter material------------------------Total length-------------------------------•------_-__ <br /> Seerp�age Pit: Distance to nearest well--- --_-.Distance fiom foundation_�d-------------Distance to nearest lot line_�l__n.. u <br /> �J Number of pits../-_- ---_--Lining material_=I?6.Sr_1t_... Size: Diameter.-__,$-��6--0�------Depth_'7f--- ---------------------- <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 fine----------------------------------------------------------------------------- ------------------------------------ <br /> Remodeling and/or repairing (describe)--------- <br /> ------ - <br /> ` -_---_- -------------------_----- <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:-------------------------------- -----------•---• - --- -------- ------------------- --------------------------------- -----(Ti+le)--------------------------------- - ---- ----..----.----------- i <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc:, can be placed on reverse side. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED B .. Of --- ------------- DATE---�l--i`.XJ -4 <br /> ---- -- - -- - - ------------------------ <br /> REVIEWEDBY----------------- --------------------------------- ------------------------------------------------------------------------- DATE <br /> BUILDING PERMIT ISSUED------------ =------------------------- --------- -. ...... - -------------- <br /> DATE------ ------------ <br /> Alterations and/or recommendations:- <br /> rx.1.¢/----,-- . r-"r - --------- ;14 --- ---- <br /> - - --- - --- -- <br /> --- ----- --- <br /> Z,.. ----- ---------- - --- ------------------------ <br /> -------------------------- ----------------­­--------------- ­- - -------------- ----------------------- - --- ---------- - -------------.--. ------ - <br /> FINAL INSPECTION B � Date..... r .... -----•----- --- - -- -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT'r <br /> 1601 E.hlasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi, California s, Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />