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-r <br /> -------------------------------------------------- --- <br /> ----------- ----- ------- --- ---------- ------- --- <br /> -------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> _ '- ------------ --- ---..--.... This Permit Ex ires 1 Year From Date Issued Date Issued <br /> L� 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 <br /> AND <br /> LOCATION_ <br /> 1�-� U. x .. _ � ►-- u- -=--------------------------------- <br /> Owner's Name---- 1/--' i --- ---- ---- -------•-------•----------------- --- ---- ------------------------------------- Phone-----•------•-----------••---------- <br /> Address --7---— ---- �----- --- --- 4 •-- c <br /> Contractor's Name - ' -------------t--- -�---------- --------------- --•--•-•-•-•--•---------- Phone.........------------------------- <br /> Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer <br /> Court E] Motel E] Other <br /> w . <br /> Number of living units: ._�Number of bedrooms - 7-._ Number of baths _X'_ Lot size -----------------________________-__-______________-______-- <br /> Water Supply: Public system ❑ Community system ❑ Private Er-"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 /> t 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---------------------- <br /> � r <br /> Disposal ield: Distance from nearest well-._.4,,P------Distance from foundation....�P___________Distance to nearest lot line._?____/_______ <br /> Number of lines---------j..----------------------Length of each line_______Y:A_--_________._.Width of trench___. ________________________ <br /> Type of filter material-____-S_tiZ_-----------Depth of filter material-------&-----------Total length___--q,0---�________________________ <br /> E <br /> 5eepa Pit: Distance to nearest wel!____1aQ_---+-Distance from foundation--------/_!�---_.Distance to nearest lot line---- -______.__ <br /> Number of pits--------/------------Lining material----- S-_lR ---_-Size: Diameter-� Depth.------- ------------------ <br /> Cesspool: <br /> -- -. <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 /> r <br /> Remodeling and/or repairing (describe):--------------------- _ __ <br /> ..... --------------------------- <br /> ----------C­zit'ef.--- <br /> --------------------- <br /> I - ------------------------------------------------ <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 ws, a d rules and regulations of the San Joaquin Local Health District. <br /> (Signed)_______ _____ ______ rind/or Contractor) <br /> BY <br /> ----------- <br /> ------- ---- -- ---- ------ `�-----------------------------------------------------------(Title)------------ <br /> (Plot plan. showing size of lot, location o system in relation to wells, buildings, etc., can be placed on reverse side). <br /> a <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_--- � <br /> REVIEWED BY - - ------------------------ --•--- DATE <br /> BUILDING PERMIT ISSUED-------- ----------------------------------- -------------------------------------------•------------ DATE <br /> Alterations and/or recommendations:------------------------- ---- --- --------- <br /> 1 i --•-------------------------•--------------------------------------------------------- ---------------------•---------•---------------------------------- -•---•--------------------------•------•-------------- .......... <br /> ------------------•------------------------------------------------------------------------------------------------------------------------------------•--------------------•-•-------------------------------------------- <br /> ' -------------------------------------------...----------------------------------------- ------------------------------------------------•------------------------------------------------------------------------------- <br /> ----------------------------------- -------------------------- ---- ------------------•--•----•-------------------- -•--------- ------­------------------------------------------------------------ ---••-- <br /> FINAL INSPECTION BY:. - -------------- Date--- - --------------------------- <br /> SAN <br /> . --- ---------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.karellon Ave, 300 West 0121 111,10 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> �i <br /> F•.P.0 O. - <br />