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-FOR OFFICE USE: <br /> --------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. r�:__7 <br />---------- -1­ - •------------------------------- -- <br /> - (Complete in Duplicate) <br /> Date issued --- <br />------------------- -------------------------==EE===E-=== i This Permit Ex fres I 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. 549. <br /> �cJOB ADDRESS AND LO ATION__�..��?.- 4 `sc -r-.....-.. -----� ------- <br /> cc <br /> Owner's Name__5__4J---- e- �-.- ----- ----=-------------- Phon ='=- ....... <br /> Address----1Q--- �-•h�--- _. <br /> I -•-••-••••-----•-- <br /> Contractor's Name-------- -------.-----•-----------------------------•---•-•-----------------------------------•-----•-•---....---------------- -- Pho` •---•-- <br /> Installation will serve: Resident Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: ........ Number of bedrooms _---__-_ Number of baths -_-__--_ Lot size =S }}�,-__.--_-. _ _ _ _________________ <br /> Water Supply: Public systemCommunity system F1Private C-] Depth to Water Table _p ft. <br /> Character of soil to a depth of�3eef: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay IxAdobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------1 N011h New,Construction: Yes . No ❑ FHA/VA: Yes ❑ No j <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public seWer 'js ava'I len 200 feet.) <br /> eptic1T-a'nk ----iDistdnce from iea�est`well .� ". -: <br /> _ sante tom foundation-------•----__----.Ma�t�f/---- - --- --------------- -�._.._-_-.�. <br /> No. of compartments-------------- _.Size- g- __ --------Liquid depth-------_'_X.)Z Capacity----Pf_•_?.-lk-__ <br /> Disposal Field: Distance from nearest well�tance from foundation -----Z"O---Distance to nearest lot line----- <br /> Number of lines----_-_-/_--___---_ -, Length of each line-_--.---.�.__0_�.. ..Width of trench................... <br /> t D <br /> Type of filter material._�T -- -_ - --- e th of filter material___----_�-- <br /> YP P ..._.-Total length -C�•------------------•--• <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line_--__-__---_----_ <br /> ❑ Number of pits----------------------Lining material......-----------------Size: Diameter.................------Depth--------------------------------- <br /> Cesspooi: Distance from nearest well-----------------Distance from foundation---._.--------------Lining material-•----------____-___._--___-___-_---_ <br /> Size: Diameter----------------------------------•--DeP th----------------------------------------------------Liquid Capacity <br /> Privy: Distance from nearest well----------------------------------------- -------Distance from nearest building---------------_-----••------------------ <br /> ❑ Distance to nearest lot line---- ----------------------------------------------------------------------------------------------------------------------------------------- <br /> F <br /> Remodeling and/or repairing (describe):-------------------------------------------_ --------------................-----------.....-------------------------•-------••-----------•---• > <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 laws, and vies and regulations of the San Joaquin Local Health District. <br /> ` --=•--------------------------------------- <br /> (Signed)- (Owner and/or Contractor <br /> BY� - ------- Title --------- <br /> (Plot plan, showing size. of lot, location of system in relation to wells, buildings, etc., can be place on reverse side). a <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----------------------- - DATE-------------------------- ------------------------ l <br /> REVIEWED BY---------------------------------------------- -- ------------------ S -•----_.. <br /> BUILDING PERMIT ISSUED..... Df4TE. ------ --- ------------------ <br /> Alterations <br /> -- ---- -Alterations and/or recommendations:-----=-------------------------------------------------- -------------------------------------------------•--- -•------ --------------------------- <br /> ------------------------- --------------------------------------------------------------------------------- ------•-----••--- .---------------------------------- -------•---------------------------------- <br /> ........................I.-..........--..---------..._._.......---r--'- <br /> -•-•--------•---•-•••--------------------------------------------------------------------------------------------- •---------•- <br /> -------------------------------------------- --------------- . --------------- ---- <br /> jI <br /> -/----�------'----•----`---'-�--- <br /> -.. ------------ <br /> ') <br /> ----- <br /> 11007/ <br /> Date-----------•----. -- <br /> FINAL INSPECTIONBY:.. . � <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Woof Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 EM 5-61 ATLAS - <br />