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21K UFFICE USE: <br /> �l - -- ......a APPLICATION F <br /> - - --------------- ---- N FOR SANITATION PERMIT Permit No. <br /> --------------------- -- ------- -------- ------ (Complete in Duplicate) <br /> --- This Permit Expires 1 Year From Date Issued 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. S49. <br /> JOB ADDRESS ALN CATION......... ... ./. <br /> 1-----•--•• <br /> -------------------------- <br /> Owner's Na -- - '.,f���,s-- <br /> /(Q ----f,� -/ --- - ---- --- ----------------------------------------------------. Phone........!........................... <br /> Address-----------•---••--- ••-•- - ---�.... _ <br /> Contractor's Name----------- - - d/" -------- 7 . ................. ................................. Phone---------'.-----•----------•------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel E] Othor❑ <br /> Number of living units: --.-_. Number of bedrooms X-__ Number of baths .�... Lot size <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table .Daft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay ❑ Adobe 2----H-ardpon ❑ <br /> Previous Application Made: (If yes,date.............-......) No New Construction: Yes ❑ No [Z}�'TFHA/VA: Yes ❑ No Kj— <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i <br /> Se tic -ank: Distance from nearest well------...........Distance from foundation ...-.-._.-.._.... Material.............. <br /> ...._................... <br /> '� No_ of compartments------------------'- ----Size--- <br /> --- -----------Liquid depth----------------4---------Ca aci <br /> Disposal Field: Distance from nearest well--,"'!_- --Distance from foundation.-.x Distance to nearest I line,l <br /> S Number of lines.......... ..... ....../' <br /> �.Len,;Length o* each line.- / <br /> /f PO-- Width of trench.-/....,_........_ <br /> Type o, filter material- ytiC�De th of filter material.- -------..Total len th <br /> ----------- <br /> dor 00 <br /> Seepage Distance to nearest well-------..........------Distance it m fo dation_.... ...._-_ Distance to nearest lot line. <br /> ------------- <br /> Number of pits......./--------- Lining material 0- .- _.Size: Diamete;:t �'�/. . ..._Depth _r•-, QO <br /> Cesspool: Distance fi•em nearest well........:........Distance from foundation....................Lining material....... .__:._.__.-----.---__-_----- , <br /> ❑ Size: D;aneter---------------------•-•••••----...Depth..----••--------------------------------_-------Liquid Capacity----- - -gals. V1 <br /> Privy: �,Distance from nearest well............. <br /> ...........`_. ................._-._.Distance from nearest building.......................................... <br /> -....._.__... <br /> ❑ Distance to nearest lot line................ ..........•-•- -4` - - .... -•-•--------•------•- <br /> Remodeling ar..d/or repairing (describe):....---•--------- ,�%.�f r <br /> ._....-•----•------- - ---------------6---------------------------------------------------------- ------------------- <br /> t <br /> -r <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 regulati ns of the San Jo u' Local Health District. <br /> (Signed) -------- ----- - ---------- ------ -_------------ ne=! r Contractor) <br /> 8y:.-. --------- (Ti+le) %3//L�' <br /> (Plot plan, showing size of lot, location of system in relati o we s, uildings, at can be place- d on reverse side). <br /> FOR dEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- -- -- - .._ ''�.— DATE------- '�l� , <br /> REVIEWEDBY ..... '------••--•---------.._...._... ..__... DATE ................................... <br /> BUILDINGPERMIT ISSUED-----------------------------------------------------------..__---••-------.--_- .. ------------- DATE....................... <br /> - <br /> Alterations and re}c�Qi�T1 nd/ations:................. <br /> .. ........................ .................................... ------------._... ... <br /> ...... ........................................ <br /> .. <br /> ........... .. e(��,.erF'w- -Lf/ -a---•---------..._-_--..._.---..-..--.-.------------- --------- ------------------------....-..-..._...._...----•-•--------------------....._..... <br /> ..............................•-•-••••------- •---•--•--••••••----••-•••--•-.----------.... ..-----------------------....................................._.................-----_-------------------•--............. <br /> ....................................................•••:--•.....------•-•-------- ---....... ...... ------------------------- --------------........•-----..------------.............................. <br /> ----------------- ------•--•-------- ...-_....---•---------•--•-•.............--................ .------------. ......... --..................................................... -----------....---------•-•-•------ <br /> FINAL INSPECTION BY:....... . --�r__-.- -...------------------. f Date.-,...... <br /> SAN'JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California ' <br />