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APPLICATION FOR SANITATION PERMIT Permit No. lh...------------- <br /> (Complete in Duplicate) v S <br /> �.,J, This Permit Expires 1 Year From Date Issued Date Issued --- <br /> Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. <br /> This.application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION....---z. d_7// -- r----- . <br /> _ .------------------------- <br /> �.7_-1 Q✓-- - G' Phone------------------------------------ <br /> Owner's Name------------- ----------- <br /> - <br /> { <br /> --------- - <br /> •--•---------------------••---------- <br /> ev5 - � «' <br /> Contractor's Name------------------------ = ------------------------------------------ Phone----------------------------------- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size -------------------------------------------------_--_--.____ <br /> Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: Yes ❑ No ❑ ' New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> Wo septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> p k: Distance from nearest well_________________Distance from foundation----___ __'-_____._.Material-_______---_-__---_--_-__-___-_--______--__. F <br /> N9o. of compartments----- •-- - Size -----------------------------Liquid depth--------- ------ ---------Capacity---------------------- <br /> D-sposal Field: Distance from nearest well._----__.Distance from foundation-----/ ..__.Distance to nearest lot line-__ _. <br /> Number of lines_____________ __ _ Length of each-line_______ _ _-_.Width of trench___.____ _�'�'��___._____.___ <br /> g - _ <br /> Type of filter material____--Depth of filter material-------��_____-._Total length__--------�--�a----------__ <br /> Seepage Pit: Distance to nearest well______________________Distance from foundation______________--__.Distance to nearest lot line----------------- <br /> ElNumber of pits-_-------- Lining material-----------------------Size: Diameter------------------------Depth------.__.----.-- ------ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-----.-------------Lining material_._.:...-----._______________..______- <br /> Size: Diameter---------------- ----------De th------------------------------.---------_ Li .uid Capacity: gals. <br /> -- }_Distance from nearest building Priv Distance from nearest wefl---�-----------=-- - ---- ------- ------ 9------------------------------------ <br /> ❑ Distance to nearest lot line--------`------------------------------------------------------------ -------------------------------------------------------------------------- ---------- <br /> Remodelin%and/or r pair;nq_Ldescribe):------------------ <br /> ---------- <br /> -------------------- <br /> ---------------- <br /> -- -- ------- i / 1l r. y ��----------- <br /> ce <br /> ------------------------•------------ ------------ --- - ------------------------------------•---- <br /> gQ-i- 7J--- v - f mac? ----,� /.►Yl ? <br /> I hereby certif that I have preps d this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Stat aw , and rules and regui of the San Joaquin Local Health District: <br /> ' --- --- (Owner and/or Contractor) <br /> [Sign d}----- --- -- - E�`" <br /> �= . --- - ----- _ L (Title) n <br /> t <br /> (Plot plan o ing size of lot, location of system in relation to wells, buildings, etc., can be placedo reverse side). <br /> r,. FOR DEPARTMENT USE ONLY <br /> 4 <br /> APPLICATION ACCEPTED SY-------------------- <br /> �--- -----------------­­ _--- ------ DATE------•--:�.. <br /> REVIEWED BY------- --------- -- ----- DATEr <br /> BUILDINGPERMIT ISSUED-------------------------------------- ---`----------------------------------- DATE------------------------------------------------------------- <br /> Alf ti ns and reco mends ions.... - ------------------------------------------------------ I <br /> ------------ <br /> `' - --------------------------------------- <br /> ----- -,���- -- �,� l <br /> ------------------------------- -- ------- ------------------------------------ - A� - May �3 <br /> -------------------------- ----------- --------------------- <br /> FINAL INSPECTION <br /> Date- (/ rt� - '�7- ---------- <br /> 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 /> ES4-2M Revised 8-'59 F.P.Co. <br /> I <br />