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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> -------------------------_1------ - ------ ( p •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. 549. <br /> i. <br /> JOB ADDRESS LOCATIO = -------- -XI/ <br /> Owner's Name--- ------- ------ ••--- ---------------------------------------- --- Phone-_ f�_ .�_ _? <br /> Address------ A------------------------ <br /> --------------------------- ------------------------------------------ <br /> Contractor's Name-r <br /> O1'L ----------------------------- ---------- ----- Phone----------------------------------- <br /> Installation will serve: Residence Z Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __1_ Number of bedrooms ---2. Number of baths -_.f__ Lot size __.,tAAPs"`a_x_: -_ -af? ._ <br /> Water Supply: Public system ❑ Community system ❑ Private C? Depth to Water Table _30 ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam D? Clay ❑ Adobe ❑ Hardpan ❑ 4Z_,%0► <br /> Previous Application Made: {If yes,}date---.'. ....... }, No 0 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 /> ElNo. of.compartments-_ ------------ Size-------------------- -----------Liquid depth--------- ...... ------- Capacity----------------------- <br /> Disposal Field: Distance from nearest well ©---_ Distance from foundation---zip----_-----Distance to nearest lot line-_•3-4'___•_ <br /> Number of lines.I--------1---------------------Length of each line_-_.-_-AZ--______-____Width of trench-.__-_r�._9_ ----_..__._------_ <br /> Type of filter material_! _ ----Depth of filter material-- _�_8"-Total length.......; I_ <br /> Seepage Pit: Distance to nearest well__ Distance rom foundation----�3.......Distance to nearest lot line...3 '__._ <br /> Number of pits-.- --f.._-_------._.Lining.material_.__ .Q_G'__<--- Size: Diameter----3.3_`�-- - -.-Deptn____��- '---.---. <br /> -Cesspool- Distance from nearest well ----------------Distance from foundation- ------------ "Lining <br /> R. ` }qmaterial- <br /> -.-....-.-.-..._--..-..--_.-----.--_ <br /> Size: Diameter- <br /> El Depth Liquid Capacity_ gals <br /> . <br /> aPriv _ Distance from'nearest well..................... __Distance from nearest building-_ <br /> f Y -� g-- ------ ----------------- - <br /> ❑ DistanceJo nearest lot line________________________ ____ <br /> i <br /> Remodeling and/or repairing IdescriF e):-- -------- <br /> ------------ <br /> - <br /> --- <br /> I I t <br /> - ------ --------- ----------------------------------------------------•--------------------------------------------------------------------------_----------------------------------------------------- <br /> �I hereby certify that I have prepared this application andrthat the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joiquin Local-Health District. <br /> � s <br /> (Signed)oi --- 4 P ---------------------------------- ------------ ----- (Owner and/or Contractor) <br /> BI Y� � 'R ' ' ------- ----- ---------------------............ -----(Title)-- -------..------------- ......... ------------ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse.side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------- - - - ------ DATE---- - --ICY '�i� ------------------ <br /> REVIEWED BY----- --------------------- - -----------------r---------r-.------ - --- ------------------- -- ------ DATE----- --- <br /> BUILDINGPERMIT ISSUED-------- -- ----------- ------- -- --------------------------------•-------------- DATE--------------------------------------------- <br /> Alterations and/or�recommendat ions------------------- .. ..----.--..._--- "--- -------------------------------------------------------------------------------------------------------- <br /> ------------------------------------ <br /> ------ --- <br /> --------------------­----------- ------------ --------------------- ------------------------------------- <br /> ---------- <br /> ------------------------------------ <br /> ------- ---------------- "-- � ----- ------------ ---- <br /> FINAL INSPECTION BY:_- ,,---------- <br /> -- ---------------------- Date...--------------f------ ------<----- <br /> - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street "-0 124 Sycamore Street 205 West 9th street <br /> Stockton,California t Lodi, California f�e Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br /> k <br />