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FOR OFHC U E: <br /> - '._f� _..___//- APPLICATION FOR SANITATION PERMIT Permit No. __...........3... <br /> f <br /> ----------------------------- ------------------------- lComplete in Duplicate) f <br /> --------------------------------------------------------- I 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 with ounty Ordinance o�r549. ' <br /> ` `t771 <br /> JOBADDRESS AND OCATIO ----- --------- --------------_------ ---------------. -.-----• ----------------................. <br /> Owner's Name........;Z1 � J --------- ---------- -------------------- Phone---...--------•------------- <br /> -- ----------------------------------- <br /> Address.•-••••._------------------- •-� - �' � ....................................................... <br /> 7 <br /> Contractor's Name ���� ---- � - - �--- --•------ -•--- ----------- Phone.............................. <br /> will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: Number of bedrooms___ Number of batlytl!s__ Lot size ...7-,6`_,Y1-3_S----- _____---__•-_--___--.- <br /> Water Supply: Public system ❑ Community system ❑ Private ❑ Depth TOWater Tableft.ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) Nope- lGeew Construction: Yes 6jo-115­❑ FHA/VA:.Yes ❑ No)99 — <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> r Septic Distance from nearest well---- Distance from foundation r'---------C <br /> --....__.Material -C ----- ...... ........ <br /> No. of compartments___________ ________Size____-� _lr Q_-___Liquid depth--_�j�r___._Capacity___( --_-___- <br /> P �� ! / <br /> Dis osal F- d: Distance from nearest well from foundation___ _______________Distance to nearest lot`line._�. __._.__ <br /> Number of lines---------- r Length of each line.... ..Width of trench-a_-Y_?�•__,`________________ <br /> Type of filter material-_.f_eZ_kit54''Depth of filter materlal___J_1r!_._.____Total length----/.nSV.1......................... <br /> -' f -- <br /> Seepage I+ Distance to nearest well-----`'-_________Distance from foundation_1/0__l--------Distance to nearest lot line----S_-.------- <br /> EV Number of pits___------------Lining material___ .lr_..Size: Diameter-----4a. ______Dept h.... S! <br /> i <br /> Cesspool: Distance from nearest well_________________Distance from foundation._.---.____-.._.--..Lining material..................................... <br /> ❑ Size:'Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity__.......................gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.......................................... <br /> ❑ Distance to nearest lot line------------••---------- 1-1...•--•..................•--•---------•----------------------------------------- ----------- <br /> Remodeling and/or repairing (describe)------------------- ------------ • ------------------- ............................I....... <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 laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)............. ----- ------- - -----•---•-- - - - �- {Owner and/or <br /> Contractor) <br /> (Owner <br /> � - - <br /> (Plot plan. showing size of lot, Ica ion of s tem in relation to wells, ur Ings, etc., can be pieced on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- __.__ — .__ --- __ <br /> - ---------------------------------------------------------------------------- DATE.. - ---- - <br /> REVIEWEDBY--------------------------------- --------------------------------------------------------------•---------------- DATE-- --------------•----------------•--------•---•-•--------- �e <br /> BUILDINGPERMIT ISSUED----------------------------------�---------� -----•----------------------------------•------- DATE-----------------------------------------------------....... <br /> Alteration and/or recommendations:.-A-- ------- _k%-----'"--------- -- ... ►�..---------------------•------ <br /> _� in _..... -s ' ...,......-----C_,--- - <br /> ------------------------------------------------------------------------------------------------------------------------------- <br /> E ---------- •------------ <br /> - -- <br /> ----------------------------------------------------------------------- ---------- --------------------------------•---------•--------- •• -------------------I——-------------• <br /> I <br /> FINAL INSPECTION BY------- -------- - ------------ Date_..-. -..t'El .. ...... ------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Weil Oak Strut 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 2M 5-62 ATLAS <br />