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FOR OFF CE USE: <br /> = � - . <br /> _.._ APPLICATION FOR SANITATION PERMIT Permit No. <br /> ---------------------------- -- - ------------ (Complete-in Duplicate) t <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. 544. t <br /> ' f <br /> JOB ADDRESS AND LOCATION. ---------. 1 ._ - <br /> "I <br /> Owner's Name_ ,/ /------ ----------------- t Phone k... <br /> Address----------- � ------t4? F Xi Cl' 7 I mss= w. <br /> Contractors Name-------- - v f- �2. = ��--------------------- ------- ---------------- ---------=----------- Phone------ ---------------------------- <br /> 1 <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Moteli❑ Other.[] 1 <br /> Number of living units: J---- Number of bedrooms _...._ 4- f-t <br /> �_. Number of baths__-- -- Lot sizeZ-t�_. c ._X <br /> Supply: Public system ❑ Community system ❑ Private [Depth to Water Table ft; <br /> k <br /> Character of soil to a depth of 3 feet• Sand [],.Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ©t Adobe`e--lHardpan ❑ <br /> Previous Application-Made: (If yes,date------------.�-_... ) No � New Construction: Yes ❑ No 0''r FHA/VA: Yes P- -No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: F <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 /> !44l r4 No. of compartments. ........ ---------_-Size---_.-.--- ---___- -------- -_Liquid depth -------- _-._. _.....Capacity <br /> s <br /> Disposal Field; Distance from nearest well__ :._..:.._._'.Distance from foundation____----------------Distance to nearest lot line____._..-._______ <br /> t S it 1' Number ofalines'-------------- -.------ ----Length of each line.- ---------------------------Width of trench------ ---------------------------- <br /> Type of filter material------ -------Depth of filter material-----------------------Total length--------.--------------------------------- ki <br /> . <br /> Seepage Pit: Distance to'nearest welL. ----..___-_-Distance from foundation_-_ ` ._____..Distance to nearest lot line__61--___._ <br /> pNumber of pits._. f----------- material�QE ... Size: Diameter.'P _Xkle__"De{nth-/��--`.................... <br /> R <br /> Cesspool: Distance ,from nearest well - ------------Distance from foundation----------------- ..Lining material------------------------------------- <br /> F] Size: Diameter- -- -------------- --`-.)....----- Depth------------------------------ ----------Liquid Capacity------------------ ---------gals. <br /> Privy: Distance from nearest well --- --------------------- -------------------Distance from nearest building------------------------------------------ <br /> Distance to.nearest lot I ... Y - ----•----------------•-------------------------- ----------+----------------- - ---------------- <br /> i < <br /> Remodeling and/or repairing �(clescribe}:- - ----....��'- ------ �/�-`�-l-�_� �'-------------------- - �---------•------••------ ---------------.. <br /> P <br /> ---------------------------------------------------------------------------•--------------------------------'-------------••------------------------------------------------------------------------------------------ i <br /> -----------------------------------------------`--------------------------------•-----------------------------------`--------------------------------------------------------------•--------------------------------- i <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with Sari Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (5i �1-- _ ��-"�---- . <br /> gned)--------•---------- - '- � - .-- /-L--- �. �" --��"��.------ ----- - - - _...(OWner-ewd/or Contractor) <br /> By: -------------(Title)-- --•---- ---- -.----------- ------ -- <br /> (Plot plan, showing size of lot, location of sy in relation to wells, buildings, etc., can be placed on remorse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY- -- - -------- -------------------------------- <br /> -- ------ DATE-- ". '6�------------------------------ <br /> REVIEWEDBY---------------------------------------------------------------- -------------------- ------------------ ------ DATE.----------------- <br /> , BUILDING PERMIT ISSUED-------- ----- ----------------- ------------------------------- ------------------------------------- DA-TE---- <br /> Alterations and/or recommendations:------------ ---- ---- --=------------------------------------------ ------------------- ----- <br /> -------------------------- <br /> -------------------------------------- <br /> --------------- ----- --- <br /> FINAL INSPECTION BY:.. --------- ----------- Date---- -.. ----6_� .D_ ) <br /> ' SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hoxelton Ave. 300 West Oak Street 124 Sycamore Street t 205 west 9th Street <br /> Stockton,California Lodi, California„ �w � 4Manteca,California �' Tracy, California <br /> E.H.9 7M 167 TVanguard Press <br /> r <br />