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FOR OFFICE USE: <br /> .................... <br /> APPLICATION FOR SANITATION PERMIT Permit No, <br /> ................ a <br /> ----------I _.... .. ........-.........----... .. (Complete in Duplicate) <br /> This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the Son 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 /> X. <br /> JOB ADDRESS AN R.xI..._ ..P Yla <br /> Owner's Name------ - - - ---..._.__...-----------•----._................ <br /> Address...-........._.. .!!/tf-. v� Ap �Sff,r- - ............... �ryr. . .... -'---......................................-.-................................. <br /> Contractor's Name------- , ' .`....-..t.'.....—.-.. ..--- -•-- - .................... Phone .......................... <br /> Installation will serve: Residence E!(Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ..._ Number of bedrooms .-... Number of baths 1.... 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❑ <br /> Previous Application Made: (If yes,date........... ) No ❑ New Construction: Yes ❑ No ❑ 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................Distance from foundation............-......Material............................................. <br /> .... <br /> ❑ / No. of compartments---------.................Size................................Liquid depth.....___---------....Capacity..........5....... ^ <br /> DispoSd( Field: Distance from nearest well...gym-.'.....Distance from foundation.-A'.0.........Distance to nearest lot line................. <br /> Number-of.lines..:........1......................Length of each line.....P2._'...............Width of trench----?r_�........--------- <br /> ...... <br /> Type of filter rteterial..:.:s�. ..........Depth of filter material......L-f.........Total length...8.a....................... <br /> Z <br /> ' Se;9P!;Pft. Distance to nearest wall......1..Ra.-' <br /> ...Distance from foundation....-./..4?.'�....Distance to nearest lot line..s........ � <br /> IZrt <br /> ❑ Number of pits::..'....'...-"'_�Cinin`g material..-_S!n&:......Size: 1)iame0er--X.'Y Q.....Depth----- .............. <br /> I • Q Cesspool: Distance nearest wall..-.....-..._...Distance from founddtion......--.,...._....Lining materiel..................................... <br /> ❑ Size: Diameter...................................._Depth----------......------....._------_------.-Liquid Capacity..........___.........gals. p <br /> Privy: Distance from nearest well------ .........................................Distance from nearest <br /> ❑ building .. ... <br /> Distance to nearest lot lire----------_...._--•......... --------......-'--------._.---------'--•'--'--... .-.'---- 051 <br /> to <br /> ' Remodeling and/or repairing (describe):................. -. <br /> :: :: ... .. . .........................._..- -' - <br /> -----------'----•--------'-----•------------- ............. <br /> I hereb c • that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, to and rules and re ulations of the San Joaquin Local Health District. <br /> d or Contractor <br /> (Signed)--- ------.....-- - _... -......................- .................... ....................... e" / ) <br /> - r------- -- - ---- ------_- -... .............................(T tla).................................... ..:............ - <br /> k (Plot plan, mg size of lot, location of ystem in lation to waifs, buddi�gi; aan'be'placed ae reverse side):- �•�^-+ <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY. .. ------•--------- -------.... DATE..J...'1.' .`.GL.......----------------- <br /> REVIEWEDBY ......................--................--.-----------------------' ....-.....-----'--............... DATE.....--- ....... .................-.............. <br /> fBUILDING PERMIT ISSUED:-----------------------...............................__.........------...................... DATE------------------------------ --- <br /> ABerations and/or recommendations:.........:...............------------------..............._..........' .........-------------------- ----____------........... <br /> ............................._...__.._......... ......................................................-..........--' ...............................• ..........-­--­------------...... -- <br /> .........................--..............................................................._.- ------- - ............................---------- - <br /> - .....---- .....--..................................._.........._...........--------.....-------.......................-- .._- .....................I.................................... <br /> ............................................... ...........-......_......._.._..-.....-....................................................................- .................................................. <br /> FINAL INSPECTION BY:e cr ."........................ Dete2:2.y..:`'. ......................... ...................... <br /> i• SAN JOAQUIN LOCAL HEALTH DISTRICT z ,, <br /> 1601 E.Xaaalton Ave. 300 West Oak Stroh 144 sycamore Street 403 Wesr 9th Areet <br /> Stockton,California Lodi,Callfornia G Manteca,California Tracy,Calif.mi. <br /> f <br />