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= FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT Permit No. _��=___-3- <br /> ` = "' -- - [Complete in Duplicate) Date Issued <br /> ---- ------------------------- _-_ This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local HealthDistrictfor a permit to construct and install the work herein described. <br /> I This application is made in compliance with County Ordinance No. 549, <br /> JOB ADDRESS AT LOCATION.__L�_ ®_ls____ . -. <br /> Owner's Name_.._ -------------- � �; - ---- ----------- ---- -- ------------------ Phone-------------------------------•---- <br /> f� <br /> I Address............... `� --------- <br /> __ <br /> e 9 - i <br /> Contractor's Name___ !t_ <br /> -• -- -- --------- --- ----------- ---- --- -- -------- ------- ---- - --- --- ---------- --------- ------ Phone------ ---------------------------- <br /> t Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel 0 Other ❑` <br /> F � <br /> Number of living units: _._ Number of bedrooms_._. Number of baths _ Lot size ----- �._ <br /> r � r <br /> Water Supply: Public system ❑ Community system ❑ Priva'te' to Water Table ------ _ ft <br /> t <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--_----._..___. I No ❑ ` New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑� No ❑ <br /> r 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..........___.-x_ ____..._______..____-_--__. <br /> ❑ No. of compartments---- ---------------- - Size---------------- --- -----------Liquid depth--------- ...... _Capacity-----------•---------- <br /> Disposal Field: Distance from nearest well__.__C.,Q.-`--Distance from foundation----- ?.._._.Distance to nearest lot line_____S._-- .-. <br /> Number of lines._-.._------1........__---_------Length of each line--.--`Ba-------------Width of trench..� .`--_--- ----------___-.- <br /> yp .-.__.Depth of filter material------ length____5/ ` <br /> Type of filter material_____�t .". £ _ o""---""-.- � C <br /> --------------------- <br /> Distance to nearest well-----/:!P .._._Distance from foundation-- /a _._._.Distance to nearest lot line___`S_-,___._ <br /> [ Number of pits.-- ------ ......_._.Lining materiaf-----4181_.__ Size: [3rcme+cr-_.. _J.X_jnr_Depth----../.3-- ---------------- <br /> ' r <br /> Cesspool: Distance from nearest wet! ________________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 lire ..__.-_............... V1 <br /> . ., � / <br /> Remodeling and/or repairing (describe):-------- -- — -- -- Y � - t <br /> -- --- -- <br /> -- ------------------=-=------------------------ <br /> r- ` <br /> -------------------------- <br /> ----------- -------------------------------------------------------------- ---------------------------------------• -----•------ = ------------- <br /> ► <br /> I hereby certify A'a+ 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 regulations of the Sen Joaquin--Local Health District. t✓ i <br /> Si ned{ g )--------------------- ---------------- <br /> --- ----- - - ----- <br /> -•----------- and/or Contractor) <br /> By: - -: .: --------------------------- .. IT e� -. _ _;......... <br /> _ <br /> (Plot plan, showing size of G+, location of system in relation to wells,,buildings, etc.,-can be placed on reverse side).- � <br /> s --- <br /> FOR DEPARTMENT USE ONLY 5 <br /> APPLICATION ACCEPTED BY_ZX ---------------------------------- -------------- DATE- I� l � <br /> REVIEWEDBY---- -------------------- ----------------- - ------------------------------------------------------------------------- ------ DATE-------------------------- ---------------------------------- <br /> BUILDING PERMIT ISSUED---------- -- --------------------------------------------------- ---------------------------------- DATE---- - ----------------------------------- <br /> Alterations <br /> --------------------------Alterations and/or recommendations:_- - ------ -------- -- --------- -------------------------------------------- ------------------•---------- ` --------••- I------------ <br /> ------------ -- -------- --------------- -- ----------------------- I I <br /> ---------•-------------------------------- <br /> --------•------------------•------------------------- -------..._..--.------------ ------------------------------------------------ ------•--- ! <br /> 4 <br /> -- <br /> __________________________ _ _ <br /> ____....._.--. ............._.-_____._.__-_-.______... ..._..._._.__.________ ._._-.__....._-.-.-.____-._...___ _ .- -..___.__. _.__.._._____ <br /> c <br /> y / <br /> FINAL INSPECTION BY: ------------- Date_.,C _.I--.. (� ---'------------ i <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT ) <br /> 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />