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FOR OFFICE USE: <br /> --------------------------------------------------------- <br /> ------------------------------------------------- ----- APPLICATION FOR SANITATION PERMIT Permit No. ....?��?3 . <br /> ------- --------------------------------------------------. . [Complete in Duplicate] Date Issued <br /> ---------------------------------------------:___._______- This Permit Expires 1 Year From Date Issued <br /> Application is hereby mace to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. : a <br /> JOB ADDRESSA LO ATION .l� -------- - <br /> -- - -- ---- - <br /> Owner's Nam - - t , s-------- ---- ---------•---------- -- --------- ----------------------- <br /> •-- --j ------- - <br /> Phone. <br /> -------------- <br /> Address------ -• - -------------•----••--------•-•--•---- <br /> Contractor's Name-,---- ---•-- ------ - ---- -- -----l- --- -------------- Phone-----------'-_------------------- <br /> Installation will serve: Residence (Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: I_____ Number of bedrooms ,2-- Number of baths r___: Lot size ___ .__ <br /> - -------------- <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ___.____ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam eClay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date----------_---------) No ❑ New Construction: Yes ❑ 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.] - 1 <br /> Septic Tank: Distance from nearest well_________________Distance from foundation-------------------Material-__------.---------------------------..______.__. <br /> ❑ No. of compartments--------------------------Size----------------------------_---Liquid depth--•-----------------------Capacity--------- ----- ----- <br /> ...r <br /> Disposal•Field: Distance from nearest well------ Distance from foundation......to--------Distance to nearest lot <br /> ' Number of lines-----------I � Length of each line------JQ_0__f----------Width of trench__�-_-__-___________ <br /> __________ <br /> Type of fter material____ O. _ .__ ---Depth of filter material__. ----------Total length---.__!�Q--- -----------__________ <br /> Seepage .v�► <br /> Pit: Distance to nearest well-_____________________Distance from foundation____._...___...._...Distance to nearest lot line__..._.-......... S <br /> r' <br /> ❑ Number of pits- -------------- - iLi material----------------------.Size. Diameter-----------------------Depth--------------------------------- <br /> .-----�. <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--`--------------------------------------------•-----------------------------------------------------------------------------------------------------_�) <br /> and/ r r p icing (descry ):------ -_ -- --`•----- ----.rs- seg .__C�{s <br /> c+�A, --- - ------- ---�---- �� ---------------------------------------------------------- ------ <br /> 1. <br /> ------------------------------------_----- ______________....-________-h_________-___---_____._ <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 /> .__ Anil or Contractor <br /> [Signed-------------- - --- -----=---------------- -- ---- --- ----- ------- - - -----------------------•---------------------------------------- -- � � ) <br /> By:--------- ------------�... -- �iion <br /> ------------(Title)------------------------------ <br /> (Plot plan, showing size of lot, location.of system inwells, buildings, etc., can be placed on reverse side). <br /> FOIL APARTMENT USE ONLY Zl_j <br /> APPLICATION ACCEPTED BY -------------- ---------------------------------------- DATE-, '271 - -771c;` ... <br /> REVIEWEDBY------------------------------------`------------------------------------------------------------------------------------------ DATE------------------------------------------------------------ <br /> BUILDING PERMIT ISSUED------ -- -------------------------------------=----------------------------------------------------- DATE----------------------------------- ----------------------- <br /> Aiterations and/or recommendations________________________ �. <br /> ---------------------------------------­-------•------------------------ ------------------------------------------------------------------------------------------------------ -----------------------•------------------- <br /> --------------------------------------------------------- ------ ---------------------------------------------------------------------------------------------------------------------------------- -------------------------- <br /> f <br /> FINAL INSPECTION BY:_ --------- -- - --- ----------------- Date................ ------- <br /> SAN <br /> -- -SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ,1601 E.Haselton Ave. — 300 West-Oak Street 124 Sycamore Street 205 West 9th Street r <br /> €[ Stockton,California Lodi,California Manteca,California Tracy,California ; 1 <br /> ES 9 REVISED 8-59 3M 3-'63 F.P.EO. <br /> 1 <br /> 1 <br />