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\ APPLICATION FOR SANITATION PERMIT Permit No. ..LcaLZZ..Q... <br /> (Complete in Duplicate) Date Issued ___ ``_s <br /> " This'Permit Expires 1 Year From Date Issued r <br /> 3Z � . ts�c�J �£! _ /p/_ CoD--©/T <br /> Application is hereby made to th San Joaquin Local Healfh District for a permit to construct and install the work herein described. <br /> This application is made in compliance w' h bounty Ordinance No. 549. <br /> JOB ADDRESS AND CATION r - ® 1 � �' JCJ { � <br /> Owner's Name0__.___ <br /> - ----------------- -------------------------------------------- Phone--------- --------------------- <br /> Address e <br /> - ---------------------------••--------•----••- --------------------- -------------•-------------------- <br /> Contractor's Name--------------- -- - - -----------•-----•-------------------------- ---------------------------------- Phone----------------------••---•------- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial' Trailer Court ❑ 'Motel ❑ Other ❑ <br /> Number of living units: _'ter Number of bedrooms .'—_ Number of baths -p-- Lot size -_._ - -_ - - ----------------------------- <br /> Water Supply: Public system ❑ Community system ❑ Private [ "'Depth to Water Table 0.�ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [] Adobe ardpan ❑ <br /> Previous Application Made: Yes ❑ No N-`)New Construction: Yes §E--lqo ❑ FHA/VA: Yes 0 No � <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tan : Distance from nearest wel _.-_Distance from foundation--- <br /> gilo <br /> No. of compartments--- -----------`-.--Size— Al �4PLiquifd depth_'.-M-.--a�teria <br /> _C_ apa_ci_ty_-%____w -_-. <br /> h <br /> Disposal Field: Distance from nearest well__, _Distance from foundation-- ._--..Distance to nearest I t line--� ------- <br /> Number of lines-------- -Length of each line_- ....._ trench­-1Z-#'�� <br /> -- � t�'d_� - Width of t�--- .-----�--------------(ri <br /> Ar <br /> Type of filter material------ epth of filter material-----Ar---- Total length-------- ,-APO---__._______--__-- <br /> Seepage P' : Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- <br /> 3 Number of pits -r------------------Lining material-----------------------Size: Diameter-----------------------Depth------------.---_---------------. <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 /> F1 Distance to nearest lot line------------------------------------- ' <br /> Remodeling and/or repairing (desc - T ---- --------------------- <br /> -------------�44�t--------- <br /> - <br /> -------------- -------- ------------ <br /> --------------------- ------------------------------------------------------------------------------------•----------------------------------------------- ------------------------------------- Op <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 r les and regulations pif the San Joaquin Local Health District. <br /> (Signed)------------------- ----`-r----- - - - •-------------------- - -- --, - - - ----------------------- - --------(��r Contrector) <br /> --------------Title____ <br /> (Plot plan, showing size of lot, location of m in relation_to wells, buildings, etc., can be place on revere side). <br /> FOR DEPARTME T USE ONLY v <br /> APPLICATION ACCEPTED BY - ---- ---------------------------------------- DATE---------- s r.. <br /> REVIEWEDBY--------------------------------------- --------- ---------- -- ------------------------------------------------ DATE-------------------------------- --------------------------- <br /> BUILDING PERMIT ISSUED------------------------------------------- --------------------------------------------------------- DATE------------------------------------------------------------ <br /> Alterations and/or recommendations------------------------- -------------------- ------------------------ ------------------------------ --•-------------•-•----------- <br /> - ---- <br /> ------------------- ------ <br /> FINAL INSPECTION BY:.. - ---- ---- Date.------- 1� P(��--------------------------------- ----------- <br /> SAN JOAQUIN-LOCAL HEALTH DISTRICT / <br /> 130 South American Sfreef 300 West Oak Proof. 132 Sycamore Street 814 North "C" Street <br /> c <br /> Stockton, California. Lodi, California Manteca, California Tracy, California <br /> ES-9--2M Rcvised 8-'59 F.P.Co. <br />