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---- ---- <br /> -_____.----_- APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------- -------------------- -------------- ------ (Complete in Duplicate) <br /> - --------------------------------------------- <br /> Date Issued <br /> This Permit Expires 1 Year From Date Issued <br /> w s Application is hereby made t- the San Joaquin Local Health District for a permit to construct and install the work herein clescribed <br /> This application is made i6 compliance with County Ordinance No. S49. <br /> r <br /> JOB ADDRESS AND LOCATION_ ` _-_3.--- -> ----- --------------- ----------------- <br /> " Owner's Name L � -------------------------------------------------------------------------- Phone. r _ �J a� �- <br /> Address -------------------- ---- --------------- - --- - - ------------------------------ <br /> 1 Contractor's Name----------------------- ------ Phone' w---'�� ----- <br /> Installation will serve: Residence [l} Apartment House ❑ Commercial ❑ Trailer Court ❑ La-- <br /> ❑ Other ❑ <br /> Number of living units: ___ Number of bedrooms _r�_ Number of baths _ _ Lot size ----h��1 d_-- - ______________ _________ <br /> Wafer Supply: Public system [-I Community system ❑ Private M-' Depth to Water Table /0 ft. <br /> I r, <br /> Character of soil to a depth of 3 feet: Sand El Gravel ❑ Sand Loam El Clay Loam E] Clay [-] Adobe C Hardpan ❑� <br /> Previous Application Made: llfyes,date-------------------) No �ew Construction: Yes ❑ No [2�FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND'SPECIFICATIONS: <br /> C (No sepfic tank or:cesspool permitted if public sewer is available within 200 feet.) <br /> ank; Distance from nearest well-----------------Distance from foundation-------------------_Material---_________._.__________._________.._______._. <br /> No. of compartments------ - <br /> -------------------Size-------------------------------_Liquid depth------------------------- Capacity ------------- - ----- <br /> Disposal Field: Disfance,from nearest well--S-C)_-----Distance from fourdation___•�_�_ __.Distance to nearest lot line_�S____________ <br /> ! Number of lines----------- _ _ Length of each line---,/V-_�__�Jr----Width of trench__ ____________-__.__ <br /> Type of filter material_____ <___ p�f�DEpth of filter material-__ ------____Total length____ _�J_____________________ <br /> Seepage Pit: Distance to nearest welt----------------------Distance from foundation--------------------Distance to nearest lot <br /> I fine_______________ <br /> ------_--Depth--------------------------------- <br /> Cesspool: Distance from nearest well ----------------Distpnce from foundation--------------------.Lining material_________.____________------ <br /> �' ❑ Size: Diameter--- ;- -----------------------------Depth--------------------------------------------------Liquid Capacity----------------------------91� . <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearesf building_-____.___________----- <br /> ❑ Distance to nearest lot line------ ---------------------------------------------------------------------------=------------------------------- ---------------------- <br /> ykRemodeling and/or repairing (describe):-------------------------------------------------------------------------------------------------------------------------------------------------- - <br /> -y <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------=---------------------------- -------------------------------------------------------------------------------------------------------------------- <br /> F <br /> — I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County G <br /> ordinances, St e laws, and rules and reg tions of the San J Juin Local Health District. <br /> (Signed)------- ---------------- --------------- - ----------— ------- �Yred/or Contractor) <br /> .By:------------------------------------------ -------------- -----(Title)--- - -- -- --------- -- <br /> (Plot plan, showing size of lot, location of system in relation we ls, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY. ------------ --------------- -------------------- '----------- E----- r <br /> - - --- <br /> ,: // ==aPBUILDING PERMIT ISSED - -',� 4 'WED BY___________________ - - . <br /> r} _ TE. <br /> ------- --- <br /> r— Alterations and/or recommendafisons: f ------_{__:. >!-------------- ----------------------------------------------------------- ----- <br /> 3' <br /> -------------•--------------------------------------------------------------------. <br /> ------------------------------------------------------------------- <br /> ------------------F-------------------- ------------------------------ <br /> ---- -- ----------- ---- ----- ----- -------------------------------------------------- <br /> ------------------------------------------------------ <br /> I <br /> FINAL INSPECTION !BY:- ------------- --- ... J • <br /> �� f ��-- --------------------� <br /> ---- ----- - --------- --� Date----- = ------ ------- -- - --------- - - <br /> f SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9tH Steeet <br />