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APPLICATION FOR SANITATION PERMIT Permit.No. ..,r____.���1.._ <br /> (Complete in Duplicate) <br /> d <br /> This Permit Expires 1 Year From Date,.lssued Date Issue <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 Ordina ce No. 9. <br /> JOBADDRESS AND L CATI N--:- ----------------------------------------•------------------------------------------- <br /> Owner's Name------ y .ted ^;ti Phone <br /> Address -------- - *` - <br /> --------==--- <br /> Contractor's Name------ -- --------- <br /> - ----------------- -'-- _ Phone <br /> Installation will serve��lR sidence (E�Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ___�•_ Number of bedrooms -- Number of bat}s _/ Lot size _ __ 4K---_�f�_______________________________ <br /> Water Supply: Public system-"p_*`Community system ❑ Private ❑ Depth to Water Table ft. <br /> Character of soil to a.deepth of 3'feet: Sand F] Gravel [ISandy Loam ❑ Clay Loam E] Clay C-] Adobe 9300'Aardpan ❑ <br /> Previous Application Made: Yes-1:1 NoAp'_'-New Construction: Yes ❑ No g_< 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 rTank:r Distance from nearest well-----------------Distance from foundation___________________Material---------------------.----------------- _-____- <br /> Ca Capacity.. <br /> { <br /> No. of compartments--------------------------Size---------- ------------------Liquid deR�h---------- --------- P Y.... -----------�-- <br /> Disposal Figld: Distance from nearest well.------ Distance from foundation_____I�______-Distance to nearest lot line.______. <br /> !� Number of lines_________f' r________ Length of each line------,�►�-i_.__-______-Width of trench_.__p .,�!___---_--_--__-- I <br /> o _ Type of filter mate rial_-_A_ ,tjj�Depth of filter material______If----____Total length--------"--e----------------------- p, . <br /> _ter• d F_f- l <br /> Seepage it: Distance to nearest well____________________Distance fr m foundation___-(______._-___.Di to nearest to line___ <br /> Number of its----/__!-______-Linin material___ -4--- Diameter-_.- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation_-------------------Lining material______________________________________ <br /> ❑ Size: Diameter------------------------------------Depth---- ;-------------------------------------------,--Li(;ui.d Capacity----------------------------gals- <br /> Privy: Distance from nearest well__________---------------------- <br /> --------------Distance from 'earest building----------.------------------------------- <br /> ❑ Distance to nearest lot line------------------- ----- ----- - ----- ------------------------------------------------------ <br /> 01 <br /> Remodeling and/or repairing (des�ribe):_____-_______4?4&­_. ­ __ - <br /> -----•-------------------------------------------------------------- <br /> --------------• ----------------------- -----------------------------•---------------------------•-••-------------------------------------------------------------- ------------- <br /> I hereby ce tify that I have prepared this application and that the work will be done in accordance with San J*aquiss=County <br /> ordinances, State laws, and rules and regulatio s of the San Joaquin Local Health District. <br /> Contract <br /> ti <br /> S rf <br /> l (Signed_ <br /> >. <br /> (Tale) <br /> By:-------------------------------------------------------- - -- - ---- - ---- <br /> (Plot plan, showing size of lot, location o stem in relation to wells, buildings, etc,, can be placed on reverse side). <br /> FOR DEPARTMENT USE-ONLY W.. <br /> APPLICATION ACCEPTED BY------'k__RAO-`-------------- -" ---------------------------------- DATE------��__ _�."f��------- <br /> REVIEWEDBY ------- ---------- ------------------------------------- DATE ---------------------------------------- <br /> BUILDING-PERMIT ISSUED- --------------------------•------------------------------•------------------------------------------ DATE_------------------------------ ----------------------------- <br /> R Alterations and/or recommendations:------- --------------------• -----•-----•-------..---------------------------------------------- ------•---- -----------------------------•----------- <br /> if <br /> r _•___________________________________________________________________________________________________________________________________________________________________________________________________________________ <br /> 1 <br /> _ ______________________________________________________________________________________________________ <br /> IN --- - - � --�--- :a Date---- = -- ------------------------------------ <br /> FINAL 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 /> 1 <br /> ES-9-2M Revised 6-'59 F.P.Co- y_ ' <br /> r <br />