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�d . _----..__.- -- APPLICATION FOR SANITATION PERMIT Permit No. ...L. <br /> �� - -_~ <br /> � �� _- � _. (Complete in Duplicate) <br /> ---- - -� Date Issued I Y <br /> E 1 x s This permit Ex Expires 1 Year From 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. _ a e in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND C TIO _- -9 e-- ---�/ --4(71V-- <br /> Owner's Name------ . <br /> -! cSF <br /> h <br /> Address---------------- �i� ay '- f! " <br /> - -•-----------•- <br /> Contractor's Name---------- -- -- ----- - <br /> i .F Phone =--'•----••-—--------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: j--- Number of bedrooms 3--- Number of baths J--- Lot size _- <br /> --------------­---------------- <br /> Water Supply: Public systerri [] Community system ❑ Private Depth to Water Table -/p ft. <br /> ■ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: If yes,dote.---___- -----1 No ❑ .'4 <br /> New Construction: Yes �o ❑ FHA/VA:Yes 94---No �., <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: f <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Sept' T k: Distance from nearest well --------- Dis#ante nom foundation-----------------_- ateriai---( <br /> P� �g _- �f <br /> No. of compartments._ -vim+_-------------Size_"__``t1���0'__•Liquid depth_-- Capacit <br /> f - -?;--------- Y �- ---- <br /> Disposal Feld: Distance from nearest well.. --Distance from foundation--/t(2----_---.Distance to nearest lot line-; ---�.-.--- <br /> Number of lines------- __ -Length of each line_-- �'� ._ <br /> P Width of trench `- <br /> ` , = <br /> T� e of filter material-�� �f�De th of filter material_-__ �i/---_Total length-.���:__-- <br /> Yp - -- <br /> Seepage Pit: Distance to nearest well---/&0__-___Distance fr m fou dation_-_- .-__-.Distance to nearest loft line--------------- <br /> Number <br /> of pits.-.I.8�►---------_-Lining material.-/-reL"__ Size:-Diameter.- <br /> - -� ,. ��_- - ----Depth- --------=---- -------'� <br /> Cesspool: Distance from nearest well---------------- Distance from foundation-_----- Lining material------------------------------------_- <br /> ❑ Size: Diameter--------------------------------------Depth---------- -----k- --------------------------.gals. <br /> ---------�- -�-�-------------Llquid Capacity <br /> 1 <br /> Privy: Distance from nearest wel-------------------------------------- Distance from nearest buildin <br /> g <br /> ❑ Distance to nearest lot Sine-------------------------------------------- <br /> -------------------------------- <br /> Remodeling and/or repairing (describe) <br /> ------------- <br /> ---- <br /> r --- <br /> ------------------------------------------•--------------- ! <br /> --------------------- ------------------------------------------------•---------------------- <br /> ---------------------------------------------------- -------------------------------------------------------------------------------•------------------------------------------------------------- ------------------- = <br /> d <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 /> J <br /> (Signed)-. <br /> ------ -- orContractor) <br /> By:--------------------------------------------- °� � 1 <br /> - i <br /> ---- (Tine) <br /> (Plot plan, showing size of lot, location of system;* �elafion to wells, buildings, etc., can be placed on reverse side). ` <br /> FOR *USE Y " <br /> APPLICATION ACCEPTED BY---------------------- C/ DATE <br /> REVIEWEDBY----------------------------------------- -------------------------- DATE <br /> BUILDING PERMIT ISSUED- = - - _ DA•TE---------------' <br /> Alterations and/or recommendations:-- - /' <br /> ---- <br /> --------------------------------------------------------------- ------ <br /> --- <br /> FINAL INSPECTION BY:... -- -•- ---- <br /> Date-------�----=>�-l�(-- ---�-` <br /> - ----�- ----=--- - - -�-'-/-..- ----�-�- �---------�-----•- -- ...A! <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street <br /> 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-$4 3M 3-'63 F.p,CD. <br /> r <br /> y <br />