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' APPLICATION FOR SANITATION PERMIT Permit No. <br /> D <br /> (Complete in Duplicate) <br /> -' to Issued ate Issued ____ <br /> This Permit Expires 1_Year From Da 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. 2– 3 <br /> JOB ADDRESS AND LOCATION------4-Q`t�--- -------0'- a- A <br /> Owner's Name---- ---------------------------------------------------- Phone__. s .U-jS . <br /> p -------------- <br /> Contractor's Name--------C._­Vili •------------------------ Phone----------------------------------- <br /> Installation will serve: Residence Apartment House E] Commercial ❑ Trailer Court E] Motel <br /> ❑ Other ❑ <br /> Number of living units: --- -_ Number of bedrooms _,_3-_- Number of baths ---/__ Lot size ---- ------------------------------ <br /> Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table ,fid_ ft. <br /> Character of soil to a depth of 3 feet: ' Sand ❑ Gravel ❑ Sandy Loam ❑ Ciay Loam ❑ Clay ❑ Adobe 0 Hardpan ❑ F <br /> Previous Application Made- Yes ❑ No 0– New Construction: Yes [s-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 feet.) <br /> Septic Tank: Distance from ne'aresf wei4--- Distance from foundation-- ----.-------Material---- �-------�----�--®-- <br /> ®_� N . of compartments----__----It 3 - Capacifiy._ <br /> o --------- X5 - <br /> Disposal Field: Distance from nearest well ] Ali .-Distance from foundation-----Lir__-_--.Distance to nearest lot line----6�_------ <br /> Len th of each line--------�4----------------Width of trench.-_------ `--------------_ -- <br /> Number of lines--------------- g <br /> Type of filter material ----;96Cct�------Depth of filter material-----,1_-6_---------Total length-------------9-y-6------------------- Com} <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation----.--------------.Distance to nearest lot line----------------- <br /> El Number of pits----------------------Lining material-----------------------Size: Diameter-------------- --------Depth-------------- -- •--------- <br /> Cesspool: Distance from nearestwell-----------------Distance from foundation--------------------Lining material------------------------------------- <br /> ElSize: Diameter----- -------"•�;-----------------Depth-----nt-----------=--------------------------------Liquid Capacity-------------------------- <br /> •gals. s <br /> F <br /> Privy: Distance from nearest well------------------------------------------------- from nearest building_----_______---_--------______-__----__. <br /> ❑ Distance to nearest loft line------------------ ---- ------------------- ------------------------------------------- <br /> Remodeling and/or repairing (describe)---------- ------------ ------------------------------------------------------------------ i <br /> f -----_-__------------------- -- } <br /> _ ------------------------------------------------- - <br /> ------------------------------------------ --------------------------------------------------------------------------------------------------- ------------------ ------------------------------------------------------ { <br /> 1 _ - -___ --- __________________ ____ <br /> ! 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 J aquin Local Health District. <br /> (Signed)--- ------ r�? ----- <br /> -------- - ----- - - ------------------ ------(Owner and/or Contractor) <br /> Title <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). 1 <br /> FOR DEPARTMENT USE ONLY <br /> O <br /> APPLICATION ACCEPTED SY____ -- ----------------------------------------------------------- DATE------ �' ---------------- <br /> i .____�i_-T�'.-_--------. <br /> REVIEWEDBY-------------------------- -------------------------------------------------------------------------------- ------- --------- DATE----------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED-------------------------------------------- --- DATE-------- ----------- ------------------------------------ <br /> Alterations and/or recommendations------------------------ ---------------------------------------•--•-----•--•---_-----------•------------------- <br /> �_- - -------- - ----•-- -------------- <br /> U� - - - - <br /> 9 <br /> --------------------------- <br /> ----------------------------------._. yr <br /> - - ----- - ._--_? __ --------------------- ----------------•---___-----_-------------;--_-_•----_-�------I----------.___-----_-.-___----_ <br /> FINAL INSPECTION -- ----- <br /> ------ --- --- - <br /> f_ . ' J ! "`"------------------------------- <br /> Date_ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 014 North "C" Street <br /> r <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M Rem sed 6-'59 F.P.Co. <br /> 7h <br />