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C-� <br />--- - ---------- --- Permit No. . . 7 <br /> APPLICATION FOR SANITATION PERMIT �•• --! -•- <br />----------- / <br /> _ - 3--- _ (Complete in Duplicate) Date Issued <br /> ..........---------_----- ---------------------- This Permit Ex fres 3 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and insF Il the work herein describe <br /> This pplicetion is made in compliance with County Ordinance No. 549. 6�1 25, <br /> Put <br /> JOB ADDRESS AN LOCATIONA4.,_I---� -2 �`�'``'1`} --,-------�--------- �........... 7- -•- <br /> Owners Name........ ..........} <br /> --------------------•-• ------- ------------------------- Phone_.._ , <br /> Address �- ._..•-•-.. --- -----------------------------------------------•---••--------•-----••--------....-----•-----••---•---....._.. <br /> ;� ------. - <br /> '� �Q- S Phone. . the <br /> Contractor's Name.._. ._:_..-=--�--=---•---• . .------••---�"�-`-�----�-�---'�--`-' -� �"�',•------------ --• ---••-•---•-•---- <br /> kJ <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ O er Qa <br /> Number of living units: ._l----. Number of bedrooms ��__.. Number of baths 3---. Lot size <br /> _2'__ ✓-..-------•-••-•---------•-•-•• <br /> Water Supply: Public system ❑ Community system ❑ Private @/Depth To Water Table Zlirft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam dClay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No'+/ New Construction: Yes ❑ No �FiA/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 Tan : Distance from nearest well-----------------Distance from foundation--------------------Material._-_----_.-.---._.-_.------------------.--------- C <br /> No. of compartments-------------------------Size-------------------------------Liquid depth__..----------------------Capacity...--------.� -- � <br /> Disposal Fiel Distance from nearest well Distance from foundation__... ._�_---.Distance to nearest lot lie_________________ <br /> Number of lines------------------ -------------Len Length of each line------ - ` Width of trench-:__. --.--.---__------_-_-- <br /> g , ---.--- <br /> �� . Type of filter material------ '-_-_Depth of filter material-. -----------i-------Total length------- .......-------- <br /> --_---f---- <br /> Seepage Pit: Distance to nearest well---1"-- ;.c......_.Distance from foundation----1.6..........Di tante to nearest lot link_- <br /> Number of pits__.-..---------------Lining material---- ) __---Size: Diameter----- Depth--- <br /> �.Q----- •��-... <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---------.-_-..----.-_---..------- <br /> ❑ Size: Diameter---------------•----------------------Depth-------------------•--------------------------------Liquid Capacity------•--------------------9als. <br /> Privy: Distance from nearest well-------------------------------------------------------- -------Distance from nearest building------------------------------------------ <br /> C1 Distance to nearest lot line---------------------------------------------` " <br /> Remo_delin and/or repairing d scribe &&r _ ------ �Q _,J4 Iq----- e 4�- ............................. <br /> --------------------------------------------------------------------------------------- <br /> ------------------•-------».._ <br /> --- ----------- ' ---_--- _ --_---...---_------..-.._-_---------_-__-_•----__-....----_-•_-----_-__-_...._-___-.•----.-.-----___•_-_---..---_-.....--••--_.-.-_--------_•.--..-----..-._.._.----------_--- <br /> hereby certify that I have prepared this application and that +he 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 /> (Signes� � ` --------------` '" ``-- '�..-- �e"=------- I (Owner and/or Contractor) <br /> .-- ------------------------------------------------- -- --•- --- Title----y� �_ <br /> (Plot plan, showing size f lot, location of system in relation to wells, buildings, etc., can be placed on reverseYside). t24 <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------- ------ -------------------­-------... DATE------------- <br /> REVIEWEDBY---•--------------------•--•--------------. --- DATE- <br /> BUILDING <br /> ----------------------------------------------------------------------------- <br /> BUILDING PERMIT ISSUED------------------------------------------- ----•---- DATE.. <br /> --------- ---- ------------_--------- -- ----­-------•-------------- <br /> Alteration red/or ecommend'a+ions------------------------ - - - �� :-------•------------•--•----•-••----------------••--••----- <br /> ---­------­ --•--•-------------•-----•---•------••--•------..---- <br /> ---------•---------•-------•---------------------------•-------------------------------•-------------------------••----------------- -------•-------- <br /> --------• --- ------ -----------------•----•--------------- <br /> FINAL INSPECTION BY------------ - ----- --- ------- Date-•----....L ` / '" - ----------- ------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 304 Wort Oak Street 124 Sycamore Street 205 Wast 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 2M 5-62 ATLAS <br />