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FOR OFFICE USE: <br /> -----_------------------_----------_---_----------------- y r <br /> ---- ---------- ------=------------- --- ------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. � ._ <br /> -------- ---------------- ---------- --------- (Complete-in Duplicate) <br /> Date Issued <br /> __ --------------- --------------- This Permit Expires 1 Year From 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. 549. /o e) UJ AX_L__ � 1� I <br /> JOB ADDRESS AND OCATION ____.__ __- -- -- ---C2 _�°'--_ _4 --- -- ---------------------- <br /> Owner's Name- ----------- - <br /> Phone----------------------------------- , <br /> -------------- <br /> Address--------------------- <br /> Contractor's KJ .. <br /> ---------------------------- <br /> Contractor's Name----- F '-- - ------- --- ------------------------------ --------------- ------- ----- Phone------ ---------------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑� <br /> Number of living units: Number of bedroomsc _ Number f baths__ .._ Lot size _____ ___ _ ______ ________ � <br /> , I <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 /> ❑ No. of compartments-------- - ---------...--Size---------------- --- ----- -_---Liquid depth--------- --- _ --------Capacity----------------------- <br /> Disposa field: Distance from nearest well......�V-.'__Distance from foundation---/.Q.-----------Distance to nearest lot line <br /> _�..____ <br /> --Length of each line__ .____106" Width of trench_.._-___...____-- <br /> Number of lines ---------�------ - - g � - - � s <br /> Type of filter material---.- --11:......Depth of filter material-----/_-__.___.__._Total length_____L- -Q______________________ <br /> Distance to nearest well----`.Ap.--1---Distance from foundation .-L.�--__.Distance to nearest lot line..__-S.�__._ <br /> ElNumber of pits--- ----/-----`--_-Lining material-----5',_ ,.._. Size: Maci;isi _Z'x./to... Depth-----ZX------------------. <br /> Cesspool: Distance from nearest well ________________Distance from foundation------------..... ..Lining material---------- --- t <br /> ❑ Size: Diameter- -- - ------------ ---- Depth---- -- --------------- -----------------Liquid Capacity. -------------------------gals. <br /> Privy: Distance from nearest well----------______-------------------------.-------Distance from nearest building-___.____._.__________-_-______...__--.. <br /> ❑ Distance to nearest lot line -------------------------- ------------------------------------------------------------------------------- -------------------------------- <br /> Remodeling and/or repairing (describe):------- ---- - --- - ------ ----------------------------------------------- <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 laws, and rules and regulations of the San Joaquin Local Health District. _. <br /> (Signed)--------------- ------ - ---------------- - - ------------------------------------. - -------------------{owner-and/or Contractor) <br /> Sy:--------------- -e x Title <br /> j�r��- - { )--------------------- <br /> (Plot plan, showing size of lot, location of system in relatiolf to wells, buildings, etc., can he placed on reverse side). <br /> Ali <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-_ ------ --- ----- ------------------ -------------- DATE-.-/ <br /> -- 4-- ---------- <br /> ---------------- <br /> REVIEWED BY----------------------------------- - --- -------------------------------------------------------------------------- DATE----- ------------------------- <br /> --------------------------- <br /> BUILDINGPERMIT ISSUED-------- -- ----------------------------------- ----------------------------- --------------- DATE.---------------- ------------ ----------------------- <br /> Alterationsand/or recommendations--- ----------------------------------------------- --------------------------------------------- ------------------- ---------------------------------------- <br /> -------------------------------------------- ...... -- --- -- ------ - ------------------------------------ ----- --- ---.------------ ---------------------------- <br /> FINAL INSPECTION BY: - Date-- ----------------------- ------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> I 1601 E.Hazelton Ave. 300 West oak Street 124 Sycamore Street 20.5 West 9th Street <br /> Stockton,California Lodi, California Mantecar California Tracy,California ? <br /> E.H.9 2M 1.67 Vanguard Press <br />