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FOR OFFICE USE: <br /> ------------------ --------------- <br /> ----------I APPLICATION FOR SANITATION PERMIT Permit No. ...4 <br /> ............. <br /> � . <br /> --------- ------------------------- ---------------- (Complete in Duplicate) <br /> t <br /> ------------------------------------------------------ --- This Permit Expires I Year From Date Issued <br /> Date Issued <br /> 4 <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 /> JOB ADDRESS AND LOCATION.___. <br /> -- ---- --------------------- ------ <br /> Owner's Name____-__ ------- ----------- ............ <br /> --------------------------------------------------------------------------------- Phone-_,------------------------------ <br /> Address.................... ------------ <br /> Contractor's Name......... --_------(_'L. -------­----I--------- ---------------------------------------------------------------- Phone........... ................ <br /> Installation will serve: Resid.. nce Apartme 1.nt�House ❑E] Commercial ❑E] Trailer Court ❑E] Motel ❑C] Other <br /> Number of living unity: Number of bedrooms 3--- Number of baths ��of size ------cl��()....K...lc3--_--------------- <br /> Water Supply: Public syste ❑ Community system El Private M Depth To Water Table ........ ft. <br /> Character of soil to a depth.of 3 feet: Sa nd El Gravel Ej- Sandy Loam E]-Clay Loam ❑ Clay E] Adobe[". ardpan C] <br /> Previous Application Made: ::(If yes,cicite_ e No El New Construction. Yes [:] No FHA/VA. Yes [] No <br /> TYPE OF INSTALLATION AND SPECIFICATIM.. <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> P <br /> e 1Sept; Tank: Distanc 'I1from nearest well--!-------------Distance from foundation-------------------Material------------------------------------------------- <br /> o. of c mpar men s-----------i--------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- <br /> Disposal Field: is once from nearest well]______________Distance from foundation--------------------Distance to nearest lot line---.__...._...... <br /> Nu ber..'f lines------------------11--------------Length of each line------------------------------Width of trench.----------------------_-.-.- <br /> e <br /> rench-----------------------------e f filter materiaL.......L----------Depth of filter.-material-,---------------------Total length------------------------------------------ <br /> Seepage it\ <br /> Dis ancel to pn,etsa rest well---------------------Distance from foundation....................Distance to nearest lot line.___.___.___-____ <br /> F <br /> Number:- ......................Lining material-----------------------Size: Diameter------------------------Depth-.------------------------------- <br /> Cesspool: Distance; from nearest well-----------------Distance from foundation__.______I__.______-Lining material------------_----_--------------- <br /> F-I Size: Dia:'6ter.------------------------------------ Depth------------------------------------tTJ-*-----Liquid Capacity----------------------------gals. <br /> Privy: Distancelfrom nearest well_____.. �------------------------------------Distance kromi nearest building______________________________....__.... <br /> ❑ Distance; nearest lot line-------0------------------------------------------------------- ----------------------------........-­--------------------------- <br /> Remod I�Z, e a' ' 1 1, <br /> _in �Io� rep irin� (�dd?escrl •----------------------- - ------ - ------------- <br /> P-44-- -- --- --- -- -------A -"L1/yN1-- - ---- ----------- ------ --- ----------------- <br /> j ------ ------------------A---------------------------------------------------- <br /> --------------- -----------I-------------- ---------------I-------------------------------------------------------------------- ------------------------------------------------------------------- ------- <br /> 11: 1 1 <br /> ---------------------------------------------------------------------------------­--------------------------------------------------------------------------------------------------._....._...----.._...------•-•---• ---- <br /> 14 I hereby certify that I have prepared this application and that the work will be d;ne in accordance with San Joaquin County <br /> ordinances, State laws, and 'A'Llies and regulations of the San Joaquin Local Health Diifirict. <br /> (Signed ........ ------------------------------------.._���ner nd/or Contractor) <br /> ------------------------------ -----(Tifley:_----------------------------------------- _----- -- ...... <br /> ------------- -------------------------------------------- <br /> (Plot plan, showing si�uf 1.I location of system in,.relation,to yells,,buildings,.efc., cati 69 placed on reverse side). <br /> FOR DEPARTMENT USE ONLY. <br /> DATE-------�O--------- <br /> APPLICATION ACCEPTED By------------- ---------- <br /> REVIEWED BY--------------------­-11-------------------------------------------------------------- <br /> -------------------------------------------------- DATE_---------------------------------------------- <br /> If <br /> BUILDINGPERMIT ISSUED-11:-------------------------------------------------------------------------------- ----------------- DATE--------------------------------------- --------------------- <br /> Alterationsand/or recommen'14ations:---- ------------ ---------------------------------------------------------------------------- --------------------------------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------- ----------------I................................................I---------- <br /> .1. <br /> ------------------------ -------------------------1--------------- - ----------------------------------------------------------------------------------- ---------------------------------------------------------------- <br /> I------------------------ ---------------- ---- .............. ------------------------ ------------------------------------------------------------------------------------------------------------------------------------ <br /> --------------- ---------------------------- ---- ----------- - ---- --- ----------------------------------------------------------------------------------- ----­--­--­-- ------------------------------ <br /> FINAL INSPECTION BY:._C_)__---- ­/6Q1.�'� <br /> --------------- Date-----------------_- ........ 7�­...... --------------------------- <br /> SA IN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Siroet 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 RM 5-62 AT I LAS <br />