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APPLICATION FOR SANITATION PERMIT Permit No. '_0)0............. <br /> (Complete in Duplicate) 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. A PX?. too <br /> :;h - - <br /> JOB ADDRESS AND LOCATION--' 27 ---- ---------- ------- ----- ---------------------------------------------------------- <br /> ------------------ <br /> -- --------- LAO <br /> Owner's Name .. ......... --- ------------------------------------------------------------------ Pho4_,__?-----------�4P----- <br /> ---------- /----------------------------------------------------------------------------------------------------------- <br /> Contractor's Name---- --------------------------- ---------------------------------------------------------------.Phone--------------------------------- <br /> Installation will serve: Residence 0 Apartment House 0 Commercial [] Trailer Court 0 Motel 0 Other IV, <br /> Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size ------------------------------------------------------------ <br /> Wafer Supply: Public system 0 Community system El Private AP- Depth to -Water Table30-- ff. <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel E] Sandy Loam Clay Loam 0 Clay 0 Adobe D Hardpan 0 <br /> Previous Application Made. Yes 0 No 0 New Construction. Yes El No E] FHA/VA.. Yes E] No El <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 nearest nt__b.d_---r-----Disfan from founclation-1-a"_____.Material__ -------- ------------ <br /> No. of compartments.----- -----.-----Size _._7A.7_---Liquid depth----- ------------Capacjfy__/40!�------ <br /> Disposal Field: Distance from nearest we1l.!F7.- Distance from foundation-,/ _--------Distance to nearest lot line--.6----------- <br /> M Number of lines___.______.._.__ Length of-each line---/" width of french------ <br /> AjW-,i!�--W- ----------------------- ------------- <br /> Type of filter material Depth of filter material___YP-_______._Total length—_l—&V.__f----------------------- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Disfance to nearest lot line______.._________ `' <br /> ❑ <br /> ine----------------- <br /> 11 Number of pits----------------------Lining maferial-------------------- -Size: Diameter------------------------Depth-------------------------------- <br /> Cesspool: Distance from nearest well_________________Distance from foundafion--------------------Lining material-------------------------------------- <br /> El Size: Diameter------------------------- ----------- Depth--------------------- -----------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well--------------------------------------------------Distance from nearest buildina---------------- ------ <br /> ❑ Distance to nearest lot line-------------------------------------------------- <br /> ------------ ----- <br /> ------------------------I---------------------------------------- <br /> Re.mocle'ng 2aid/or repairing (de 2tribe ---------------- -------------- <br /> ------"A.P. ----------------------------------------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, to laws, and rules and rewlations of the San Joaquin Local Health District. <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 placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY___.,.� .--- --- --------------------------------------------------------- DATE_47__Aa�A__--r7P--------------------------- <br /> REVIEWEDBY------------------------------------------ -- -------------------------------------------------------------------------------- DATE----- <br /> BUILDING PERMIT ISSUED-------------------------------------------- -------------------------------------------------------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:------------------------- ------------------------------------------------------------------------ ---------------------------------- <br /> ------------------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------- ------------- ----------.................................... ...................................­.......­­­­_ <br /> ----- --------------------------------------------­­-----------------------------------------------------------------------------------------------------------------------­------------------------------------------ <br /> ­-----------------------­---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> .., 4 Date._.tp ----------------------------------------- <br /> FINAL INSPECTION - ----------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M Revised 1-57 F,P-CO. <br />