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F FOR OFFICE USE: q f(V 2. A- <br /> d6y 3 `� <br /> APPLICATION FOR SANITATION PERMIT Permit No. ..... <br /> r ._. --- -- ----------------- - ------ (Comple+e-in Duplicate) <br /> ,,. <br /> Date Issued _._�T.�..-=.lr-_.- <br /> ---_-----�t--._--_- This'Permit Expires 1,Year From Date Issued' <br /> ApplicatioAs 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 /> JOB ADDRESS AN CST N. � --� ---/�`-- <br /> Owner's Name ----=- ---- <br /> --------------------------------------------------------------- ---------------------------- ------------ Phone......----------------•----- <br /> i Address - = <br /> -i <br /> ---------------e <br /> Contractor's Name l '~� Phone------ ---------------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial,E] Trailer Court ❑ Motel ❑ Other p <br /> Number of living uiiits:,.l---.:,Number of bedrooms ..,Number of baths../------Lot - .._......--- ----------------- <br /> Water Supply: Public system le--community system ElPrivate ❑ Depth to Water Table ,�Ot <br /> I Character of soil to a depth of 3 fee+ Sand ❑ Gravel ❑ Sandy toarlr ❑ Clay Loam ❑ Clay ❑ Adobe grT-Iardpan ❑ <br /> Previous Application Made:—(-If yes,date_.__.._:.- ) No [ New Construction: Yes R2/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 fee+.) <br /> /p <br /> Septic IT Distance from nearest well_." ____Distance from foundation--�L?------......Material .��T+E..........................__.-._... <br /> No. of compartments..._..............Size..-, .C .. --Liquid depth.- _--_._- .__..--- <br /> Capacity_= � <br /> Dispo al ield: Distance from nearest well....'""-_-_-Distance from foundation--Al............Distance to nearest lot line."_...... <br /> Number of lines..-l--.s..... ...............Length of each line-. 9A_ ._ of trench. <br /> .. ... ..'-..__--.-..... <br /> Type of filter material__._�C_1LA:_--Depth of filter materiaL._.l$'. Total length___-_.. fJ..,..................... <br /> Seepage fit: Distance to nearestll <br /> we ..-..-.`.-- ... <br /> - ...Distanc'_e4rom foundation__1Q__1-----------Distanif to nearest lot line.-6 <br /> Number of pit -. _j_. Lining material. . .__ Size: Diameter_-__- __------Depth--- �..�'.-___.._.__-_- C <br /> Cesspool: Distance from nearest well ----------------Distance from foundation___------------- ..Lining material-_____.....------------------------.. (` <br /> .: ❑ Size`. Diameter1-- -------- ----- - --------------Depth----- --------- ----------------------------- -----Liquid Capacity----------------- ----gals. <br /> Privy: Distance from nearest well------.------------------------------------ =Distance from nearest building-------------------------------.---------. f <br /> ❑ Distance to nearest lot line------------------ - ---------- ------------------- -------------------------------------------------------------------------------------- <br /> r Remodeling and/or repairing (describe):----------- --------------------------------------------------------•- ------------- •------------------------ <br /> ----------------------•----•---•------•-�------------------------------------ ------------------------------------------- ----------------------------------------------------------------------------------------- --- <br /> 4 t, <br /> 1 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 r s and regulations of the San Joaquin Local Health District. <br /> ------------------ <br /> (Signed) (Owner and/or Contractor) <br /> ------------------------- -- -------------- <br /> By------------------------------------------ <br /> .......................... <br /> .---------- . -------- .-------------- .....------------------.------------------(Title)----------- ----- ----------------...... <br /> ...... <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 /> I <br /> APPLICATION ACCEPTED BY---- ----- -_------------- ------ ---------------------------------------- DATE------ ------- -�--------------------------- <br /> REVIEWEDBY---------------------------------------------- --- ------------------------------------ -------------------------------------- DATE----------------- ------------------------------------------ <br /> BUILDINGPERMIT ISSUED-___--- -------- ------------------------ ­----------------------------- DATE--- ---- ------------- - ---- --------------------------- <br /> Alter tions and or rec mmendations:... -- /= <br /> - <br /> 4 <br /> --- <br /> ............. � - - <br /> - -------------------------------- -------------------------- ------ --------- --------------------------------- -- <br /> �- �y� � D L <br /> FINAL INSPECTION BY:..-.Il_v.I'-�� — �l--------------------- <br /> Date--- �. ..- .O - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxellon 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 />