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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT Permit No. ./&. ....... . <br /> - ----- --------------------------------------- (Complete in Duplicate) / (S <br /> --.,.. This Permit Expires 1 Year From Date Issued <br /> 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 wi .County Ordinance No. 549. , �_O�J=^ Zf Z-f 10-S <br /> � •' ,f� / ],. `- t� �- " <br /> JOB ADDRESS AND L TION � £t •'llr . %LcP�.-1 �l - �1N1 <br /> Owner's Name-------- - ��� 1�- -E. 1 'Phone...... <br /> Address •' -� � `' � --------•-•- <br /> Contractor's Name----------------------- i' .....-------- -----•--------•------------- -----------�---------- Phone----------------------------------- <br /> Installation will serve: Residence Ap dent House ❑ Commercial ❑ Trailer Court E] Motel Other El <br /> Number of living units: ...._.. umber of bedrooms ---1--- Number of baths __j... Lot-size .... 4_----------------------------- <br /> Water Supply: Public system ❑ Community system ❑ Private�Depth to Water Table ----- -- ff. <br /> 4 Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) Nox New Construction: Yes No E] FHA/VA: Yes [] No <br /> i TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.), . <br /> I Sep is Tank: Distance from nearest w Il... ----.Distance froVA-'_:��L-iq, uid,-depfh <br /> aundat�n..-�---------..Mate iia I-/ _-............. <br /> � .r�.. <br /> �`•'�•`No:�of"com�artan�nts=---- -�-. ,�Size��- ----- J � �-------p � - �/ -------- - -� --Capacity.��----_-=----��.._ <br /> Dispespil Field: Distance from dearest well..------- rDistance from found ..- <br /> atio __..-_D...Distance to nearest lot lint <br /> Number of lines.-.-."�.� ._.- -_Length of each line_..._ _--. .._-_. Width of trench.... . .. ... <br /> JA Type of filter material-Com._{.-:Depth of filter material------- 4 -. ..-._Total length---._-.---F�..... .............. <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 /> Cesspool: Distance from nearest well-----------------Distance from foundation ........Lining material....----------------------_---.._.- �b <br /> ❑ Size: Diameter--------------------------------------Depth--------------------------------- - ----------------Liquid Capacity------------------------ ---gals. 1 <br /> c-�.Privjr _-Ui_tan�ce";"Tsom near �.. .T. -.. — �_ _. . .,.ear6 e..------ . <br /> est welt...._._._._.......___..---_ --.____Distance fromnearesf buildin� -- <br /> ❑ Distance to nearest lot hne------------------------------------------------------------------------- -------------------------•------------- --------------------------- <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 rules and regula ions of the San Joaquin Local Health District. . <br /> (Signed)----= F' = `,Z''�1.... .. - - (Owner and/or Contractor( <br /> S <br /> ' <br /> By:-------------------------------------------------------- -------------------------------------------------- -- ---(Title)--------------------------- <br /> 1 . <br /> (Plot plan, showing size of lot, location of system in relation jo wells, buildings, etc., can be placed on reverse.side). <br /> FOR DEPARTMENT USE ONLY w. <br /> i APPLICATION ACCEPTED BY-- -------- ------------ --------------------------------------------------- ! Z_ ATE------ ------- > <br /> �. — � ------ <br /> REVIEWED. BY ------- -----•- - • DATE �� 1. . _ <br /> BUILDING PERMIT ISSUED----------------------------------------------------------------------=-=------------ -----------=- DATE-------•----------=-------- <br /> - -- --------------------------- <br /> Alterations and/or recommendations:--------------------------------- -------- --------------------------------------------- <br /> ----------------......--..----------------------------------------- <br /> --------------------------------- ---------------------------------------------------------------E <br /> .--------------------------------=---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------- ------- --------- -------------------------- :----------------------------------•---------------------------------- --- <br /> ----- ------------- ----- <br /> �, t <br /> FINAL INSPECTION BY-----------------`--- bete <br /> ~ - -------`=--------- ------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED B-59 3M 3-'63 F.F.CD. 1 ti <br />