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FOR OFF( U <br /> -------- ------ / <br /> --- <br /> -----------_--- APPLICATION FOR SANITATION PERIT Permit No. ..... S- �T <br /> -------------- -------- .._.. ---- -- (Complete in Duplicate) <br /> Date Issued ... <br /> -_---------------------------_._.._._______.____._.___ This Permit Expires 1 Year From Date Issued <br /> ..�,---------------6� <br /> Application is hereby made to the San Joaquin Local Health 'District for a permit to construct and install the work herein described. 4 <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION-----------3-3----Z--`�-------- ---�-=--------- r�'�`�'�`------------------------------------------- ----------- <br /> Owner s Name-------------- . . ••---•--- <br /> ' Phone. o L <br /> ------------------------------------------ <br /> Address----------------------------------------------------------------�- " `- •. <br /> Contractor s Name--==------------------• ......----...•-�-- - r-�-G--- Phone <br /> Installation will serve: '`Residence ❑ Apartment House ® Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units. __y`?'_ Number of bedrooms Number of baths __Y__ Lot size _-------------2--_--- . ............ <br /> Water Supply: Public system a Community system ❑ Private ❑ Depth To Water Table _!- ft. <br /> Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑" Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No [:j New-Construction: Yes ❑ No a FHA/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 Tank- Distance from nearest well_________________Distance from foundation_______-•-_--------Material---------......-_................................ <br /> No. of compartments--------------------------Size---•----------------------------Liquid depth--------------------------Capacity---•------------------- <br /> Disposal Field: Distance from nearest well----_________....Distance from foundation____. "a..__.Distance to nearest lot line..... <br /> �i- Number of lines________________-___----._.__._Length of each line-----------3---s?----------Width of trench.-.............. <br /> Type of filter material.____ Depth of filter material_..-.__l�"'__.__Total length............. .-e--- __________________ rk <br /> Seepage Pit: Distance to nearest.well__ _._Distance from foundation_____3.!� .......Distance to nearest lot line______3-. <br /> „❑ Number of pits__ ----/------------Lining material-__4 -_Size: Diameter-_-_--z�_:C.___-Depth_________2__,z'.............. <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material___.______-.________-___.-__--_-_-•-- <br /> ❑ Size: Diameter--- _p----------Depth---------------------------------------------------Liquid Capacity----------------------------gals. <br /> �T _.---.-Distance from nearest building Privy: r-r" Distance from nearest well----------------------------------------- 9----•---•--•------------•-•--------------- <br /> ❑ I Distance to nearest lot line-------- ____________________�____._._______ _- <br /> _. -�� -�-�-P-- <br /> --Remodelirg.an /orepairing (descri6e). ,__ � <br /> .. . ---- ----- -l------1 - <br /> ` <br /> ----------- ) ---------N----------••-----------------------------._...-.......----------•---------•-•----------------------------------------------------------------------------------------------- <br /> r 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 end regulations of-the San Joaquin Local Health District. <br /> (Signed)----- •-- --- -•- /- -----------=-------------------------------------•---------------------------.-.-----------------(Owner and/or Contractor) <br /> B - -------•----------------------------------�1�. =- -----------------'---------------------------------------------(Title)----------------------- ------------------ - - ---------------- <br /> (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> NFOR RTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------------Z­-:r � - - ------------------------------ DATE-------- � <br /> . ---------------------- <br /> REVIEWEDBY--------------------- ----------------------- ' ---------`-`0--------_-------- DATE-----------------------•----------------------------------- <br /> BUILDING PERMIT ISSUED <br /> - .* --------•------------------- DATE------------------ <br /> ------•------------------------------------ <br /> Alteratio m ---- --- = -- .......I...... ---------------•--------•------- <br /> -1` -�-3 — -•-- '------ `--,' lc <br /> ./ ............ --------- <br /> -----•--------------------------------------------- -­------------- ----- --- -•------------ ----------------------------------------- ........ •---------------------------------------- -------- <br /> FINAL INSPECTION BY:----- 6 �-- .�----------- Date /- 13.--------•------••----- - <br /> 1 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9Th Street <br /> Stockton,California todl,California Manteca,California Tracy,California <br /> ES 9 REVISED a-59 2M 5-62 ATLAS <br />