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---------------------------- ----------- - <br /> �-------------------------- APP` ,ATION FOR SANITATION PERM?'% Permit No. .__�.b_1....__ <br /> -------------- '---- ------------------------------------ r (Complete in Duplicate) <br /> --------- ------r--------------------- ------------------ This permit Expires 1 Year From Date Issued Date Issued .__ f <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> 1 This application is made in compliance with County Ordinance <br /> nce No. 549. •� -A.-.:L <br /> JOB ADDRESS AND LOCATION__- / ` <br /> ----- -------- ---., ------- ` <br /> Owner's Name. r ' � O� <br /> ----------------- PhonC <br /> Address--------------•---/ /, <br /> -----_----------- <br /> Contractor's Name.... '------ ----------------------- Phone----•-------••----------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court [-I Motel ❑ Other E] <br /> Number of living units: _1____ Number of bedrooms _-�___ Number of baths______ Lot size -----� <br /> Water.Supply: Public system ❑ Community system ❑ Private E� Depth to Water Table L4-'D- 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,dote--------------------) 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-_'6__."______Distance fro foundation______-b________-Material____ <br /> No. of compartments_----�--- -- - -------Size..._ -- - -k- ---Liquid depth----- ------------------Ca aci <br /> Disposal Field: Distance from nearestvell3'�_9_----.-Distance from foundation___�-0--___--__-Distance to nearest lot line_$__/ <br /> Number of lines__- Z--------- ----------- Length of each line __b-_ {� % A <br /> Width of trench--- F . l" <br /> Type of filter material__ De.pth of filter mafierial___-l ____-______-Total length____-2._'�.a_------------ <br /> -__ <br /> ` Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line__-._-____-_____ <br /> ❑ Number of pits----------------------Lining material----------------------.Size: Diameter---------- ----.Depth---------------- � <br /> I Cesspool: Distance from nearest well________________ Distance from foundation--------------------Lining material - <br /> Size: Diameter _-__-. <br /> -------Depth--------------------------- ------------------------Liquid Capacity---------------------­-----gals, <br /> Privy: Distance from nearest well-_------------------------------------------------ Distance from nearest building---------- <br /> •--- -... <br /> ❑ Distance to nearest lot line <br /> ---------- ------------- <br /> r Remodeling and/or repairing (describe)--------------------------------------------------------------------------------- <br /> ------------ <br /> ---------------------------------------------------------- <br /> ------------------------------------------------------------ <br /> ------------ ---------------------------------------- <br /> G <br /> - ----- -------------------- -----------------------------------------------------------------------------------------------------------------------••---------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------- <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinanc . ,._Sf�te laws, and rules and regulations of the5/�n Joaquin Local Health District. <br /> (Sign 4�_ - ,4- �^ �. - • � -^ <br /> t ----------------------------_ net an r Contract <br /> 0 or) <br /> By--------------------------------------------------------: <br /> ---------------------•-------- ----------------(Title)---------- ----------- ----------------- ----- - <br /> (Plot plan,.showing size of lot, location of"system in relation to wells, buildings, etc., can be placed on reverse side). <br /> F FOR DEPARTMENT USE ONLY <br /> f <br /> APPLICATION ACCEPTED BY- <br /> - - -- - - -- ........................ DATE----'----?---(C <br /> -------------- <br /> - ------------------------ <br /> REVlEWED BY------------- ----------------•-=--- ---- -�-------------- - -- DATE------------•------------------ •- <br /> ------------------- -------------- <br /> BUILDING PERMIT ISSUED ------------ <br /> ------------------ <br /> -- --- -- ----- --- <br /> /�,,�- - -- - - -------- <br /> -- <br /> Alterations and/or recommendations:--------- �'" U d '..� <br /> ------- --------- <br /> ------------------ - ------ <br /> ------- --------- - - <br /> :"a� '�'�'L'� ---- /_-=�'�---------- --------.-.lt r te! • _._ <br /> _. r <br /> �°-�- 3 - -- - - -- ---------------------- ----------- ------ <br /> FINAL INSPECTION BY:-------------------------------------- ------------------------ Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Naselton Ave. f <br /> 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.RCo. I <br /> r <br />