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ilotew-'FOR OFFICE USE: <br /> d <br /> ----------------- <br /> ,5----------------------may--_- APPLICATION FOR SANITATION- PERMIT Permit No. <br /> ---------------------------------------------------------- (Complete in Duplicate) 'Date Issued <br /> ------- -- ------- ------------------------------------- This Permit Expires I Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and installthework herein described. <br /> This application is made in compliance with County Ordinance No. 549, <br /> JOB ADDRESS AND)LOCATION---- ------e4a6- --------------------------------------- <br /> Owner's Name- ---------- ------------------------------- ---- - ----------------------------- ------ Phone...-•-----_----------------------- <br /> Address------____-- <br /> -_----------------------- <br /> Address---------hl��_ ----------------------------------------------------------------------------------- ------------------------ <br /> Contractor's Name------ - --------- - ------------------------------------------------------------------------------ Phone------------------------" <br /> Installation <br /> hone-------------------------Installation will serve: Residence 92,-'Apartment House.[I -Commercia 1 0 Trailer Court ❑ Motel 0 Other E] <br /> Number of living units: _/__ Number of Number of baths /__ Lot siz ---7---,v----------------------------------- <br /> Water Supply: Public system [] Community system g?"OFrivate E] Depth to Water Table t <br /> Character of soil to a depth of 3 feet: Sand E <br /> Gravel ❑ Sandy Liam _Clay Loam 3 Clay EAdobe - ardpan E <br /> Previous Application Made: (if yes,date-..-.---------------) No Z�-�ew Construction: Yes gj-'no E] FHA/VA: Yes �'No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is availa6le within 200 feet.) :1 <br /> Septic Tank: Distance from nearest well________________ <br /> Distance �Prn found I flon__/�;?---------M a ty i I <br /> No. of compartments-,02—------------ Size"_x oq­, Liquid deph_ ------- --Capacity- - -- ------ <br /> J: <br /> Disposal Field: Distance from nearest well-------I......�Distance from fouridafion--Z407------/-Distance to neare'st lot line-t;------------ <br /> Number of lines-- Length of each IineA96_0_1_tjZ2....Width of tren,h-i-A.......... <br /> epth of filter material--- ------Total length ..;3-------------------------- <br /> �_A ------------ <br /> Type of filter maferi <br /> Seepage P' Distance to nearest well-----—------Distance from foundationL - - ---------� s a to.nearest lot line-to----------- <br /> 40"2 406� 4 oy .9 <br /> -Number of pifs__'1_21-------------Lining material_,e"_-,v------- Diaimefer.�� Depth <br /> Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material..-.---------------------------------- <br /> ElSize: D ia mete ---------------------4-----------------------:_--tJ-qaid-C-dp-a-city----------------------------gals. <br /> Privy- Distance.from nearest well-------------------------------------------------Distance from nearest building--t--------------------------------------- <br /> El Distance to nearest lot line----------------------------- ------- - ------ -------------------------------- I <br /> ----------------------------------------------------- <br /> Remodeling- and/or repairing (describe=-------------- - ----J-------- -- ------- -- ---- -------- <br /> ------------------------------ <br /> ----------------------------------------------------------r:--------------------------------------------------------------------------------- ------------------------------------------------------------------------------ <br /> ----------------------------------------------------------f-----------------------------------------------------------..........­--------------------------------------------------- ---------- <br /> I I <br /> ------------------------------------ -------------------J-------------------------------------- <br /> ----------------------------------------- <br /> --------------------------------------- <br /> 1 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 rulps and regulations of the San Joaquin Local Health District. <br /> (Signed)----- ---------- --- -- --- --- ------- ---------------- ------ - --- --------------------------------(Qmwf==m=Wor Contractor) <br /> I <br /> By:.................... --------------------------------------------------- --- - 6- w-_ -- - - - - ----------(Title) ------ <br /> (Plot plan, showing size of lot, location of system in a n ells, buildings, etc., can be placed on reverse side). <br /> 06R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------- ---------------- <br /> ---------------------- <br /> ------------------- DATE------- -------------- <br /> REVIEWED BY-------------------- -- <br /> ------------------------------ ----------- ----- -------------------------------------------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED-------------------------------------------r- ----------------------------------------------- DATE------------------ ------------------------------------------ <br /> Xiterations. and/or recommendations:-..--- <br /> ---------- <br /> ----------- - <br /> ----------------------------------------------- ---------------------------------------- -------------------------------------------------------------------------------------- ---------------------------- <br /> -- -------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------ ---------------------- - ------_---------------------------I----------------------------- ---------------------------------------------------------------------------- <br /> ------------ -------------- - -- -- - -------- ------------------------------------------------------------------------------------------------------------------------ -------------------- -------------------- <br /> - ,, -1 --- <br /> ------------------------------------- <br /> LNAIL INSPECTION BY:-- / / , - <br /> -- -- ----�5--------- ----------------- -- Date---- <br /> rSAN JOAQUIN LOCAL HEALTH DISTRICT.j <br /> 7601 E.Haxellon Ave. 300 West Oak Street 1-24 Sycamore Street e 205 West 9th Street <br /> Stockton,California Lodi,,California Manteca,California Tracy,Coliforni3 <br /> ES 9 REVISED 15-59 3M 3`63 F.P,CEI. <br />