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----------------------------- -- ------------------------ <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> -------------- ------- - -- --- ------------------------ <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 Health District for a permit to construct and insta iI the w;07,k herein qIescribed. <br /> This application is made in com�Iiancp with County Ordinance No. 549. <br /> JOB ADDRESSANFD LOCATIP_Of�d,_�� _­_ ------k-s-ov- Tlorkli�jvfl <br /> ------------------ ----------------------__). ..........--) ------------------------------ <br /> Owner's Name------------ <br /> Address _ <br /> Contractor's NameD-• --------•-- a - - - -- ------ ---------------- ----------P--h--o--n-e---- <br /> Installation. -------------------------------------------------------------------- <br /> - <br /> will serve:. Residence &---Apartment House E] Comn't-5rcial E] Trailer Court [] Motel [] Other ❑ <br /> Number of living units. __/--- Number of bedrooms _2__ Number of baths -2--Lot size __/j_4_,_f7_'__,X_ ----I/ <br /> _c7_V-__- ---------------- <br /> Wafer Supply: Public system E] Community system [I Private E&,1:re_ptk to Water Table jo__ <br /> Character of soil to a depth of 3 feet: I Sand E] Gravel E] . Sand Loam lq__�Clay Loam [] Cl y E] Adobe [] HardpanE3 <br /> Previous Application Made: (If yes,date--------------------I No [P,0`0,New Construction: Yes � 1'0 FHA/VA: Yes El No Vi/ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if-public sewer is available within 200 feet.) <br /> Septic T�p k: Distance from nearest well--6-0-4----Distance from founclationA Material---- ........... C> <br /> No. of compartments------- -2-------------Size_��----K-Y--- Liquid d,pth-------/%,x--------Capacity-6570------------ � <br /> F; --------- <br /> Disposal eld: Distance from nearest well ___,P---0-.Distanc-e from foundation--_1--0-1------Distance to nearest lot <br /> Number of lines-_--:—------ Length of each line---- ¢---4,(--�49.W i dth of trench- ;-,->-,V- ------------- <br /> e <br /> A 0 *10 <br /> Type of filter material---- ------- ---- pth of filter material... -----Total length----- ------------ <br /> ------------- <br /> Seepage Pit: Distance to nearest well------- --------------Distance from foundation--------------------Distance to nearest lot line------------- _ <br /> E-1 Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------_-_-_---_------___------ p <br /> Cesspool: <br /> epth------------- ---------------- -- <br /> Cesspool: Distance from nearest well-----------------Distance from found.ation----- --------------Lining material------------------------------------ <br /> 171 Size: Diameter--------------------------------------De th- ---------------------------------------------------Liquid Capacity- -------------------------gals. <br /> Privy- Distance from nearest wefl-------------------------- -------------Distance\from nearest building-_--------------------_------_------ <br /> ElDistance to nearest lot line---------------------------------------------- ------------------------ --------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):----- ---------------- ---- <br /> -.11------ ------1141��--- <br /> ----------------------------------------------------------------------------- -------Z------------------------------ ---------------------------- ---------------------------------- <br /> ----------------------------------- -----------------------------------------------------------------------------------------------------------------------------------------------------------------­­­------------------ <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 lawT>, nd rules andl-im.,pulations of the San Joaquin Local Health District. <br /> (Signed)------------- Q -- ----- ---------------------- -----(Owner and/or Contractor) <br /> By:------------------------------ - --- -------------------------------------------------------- <br /> (Title)- ---------------- <br /> - ---- ------------ <br /> 6------ <br /> (Plot plan, showing size of to I cation of system in relation to wells, buildings, etc., can be placed on reverse side.' <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY-------------- -- --- --------------------------------------------- -------- DATE-------- ----------------- <br /> REVIEWEDBY-------------------------------------------------------------------------------------------------- --------------- DATE---------------- ------------------------------------------- <br /> BUILDINGPERMIT ISSUED--------------------------------------- --- ---------------------------------------------------------- DATE---------------------------------------------- - <br /> Alterationsand/or recornmendaf ions:-------------------------------------------- ---------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------- ------------ ------------------------------------------------------------------------------------ ------------------------------------------------------ <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------I-------- --------- <br /> -------------------------------------------------------------1-------- -------------------------------------------I-------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------- ------------------------ ---- ----------- ------------------ ------------------------ -- ------------------------------ ------------------------------------------ <br /> FINAL INSPECTION BY: wo-- --------------------------------------- Date. . <br /> _1_76/_ ----------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxellan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> F.P.CQ. <br />