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FOR OFFICE USE: <br /> 2/ --------------------------- ' <br /> ,�a - APPLICATION FOR SANITATION PERMIT Permit N0 ...... <br /> ------------------ -----I--W------------------------- <br /> ------------- ---------------------- (Complete in Duplicate) % Date Issued �,1 -4/_ <br /> -------------------------------------------------- This Permit Expires I Year From Date Issued <br /> Application is hereby made to the Son Joaquin Local Health 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 <br /> 6 Ve" ---=---•---------------------------- <br /> _1f <br /> ----------------____--------_- <br /> ;-------------------------------------*-----------------------------------------------­*--------------- <br /> Owner's Name--•• ------A, ---—------------------------------------------------ -------------------------------------------- Phone-------\------------------------- <br /> Address--------- ..._dal-P-111----------------------------------------------------------------------------------------------------------- " ------------------------- <br /> ---- -------------- ------------** <br /> Contractor's Name.-------- --------- ---------------------------------------------------------------------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence �- Apartment House E] Commercial 0 Trailer Court [j 'Mofel E] Other E] <br /> Number of living units; --I--- Number of bedroom*s __3__ Number of baths __/--- Lot size ___74_X40P-------------------------------- <br /> Wafer Supply: Public:system 9!r-Community system [_1 Private 0 Depth to Water Table 48'71'ff. <br /> Character of soil to a depth of 3 feet: Sand [] Gravel E] Sandy Loam El Clay Loam El Clay 1:1 Adobe4B'Hardpan 1:1 <br /> Previous Application Made: (If yes,clate------------------ ) No Jg- New Construction: Yes 21-'No El FHA/VA: Yes E] No Rte' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available Within 200 feet.) <br /> I <br /> Septic Tank: Distance from nearest well__:�7= ------- Distance from founclafion-19------------Maferial---- ------------------------------------------- <br /> 2� No. of comparfments--2-------------------- Liquid deptk_____1;r---- ----capacjfy___r_a��---q"( <br /> Disposal Field: Distance from nearest well-- *- -------Distance from founclation-Z-0.. ...... Distance to nearest lot line.-A----------- <br /> Number of lines--------'Z---------- ------------Length of each line----;715�_!---------_Width of trench---cZ--Y---4----------------- <br /> Type of filter maferiaI_____7Fe2.C_A___Depth of filter material---- <br /> - ---------- <br /> Seepage Pit: Distance to nearest well,--—-----------Distance from foundation-40-_------Distanc.e to nearest lot lines—-------- <br /> E!r-- Number of pits-------9.----------Lining maferial--RIACA- -- <br /> -- -Size: Diamefer_-X.�------------Depth---AS____________________ <br /> - - <br /> Cesspool: Distance from -nearest well-----------------Distance from foundation--------------------Lining material__._._____-_____________._______.___. 6 <br /> F-1 Size: Diameter-------- Depth:_"---------------------------- - -------- --------Liquid Capacity----------------------------gals. <br /> <f I <br /> Privy: Distance from nearesf.well-------------------------------------------------Disfance.frorn.nearesf building----------------------------------- ------- S> <br /> F1Distance to nearest ]of line----------------------------------------------------------------------------------------------------------------------------:---------------- <br /> Remodeling and/or repairing (describe):-- -------------- ------------------------------------- --------- ------------ ------------------------------------------------------- <br /> - --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -- <br /> - ---------------------------- ------------------------------------•-----------------------­--------------------6------------------------------------------------------------------------------------------------------------- <br /> --------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <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 rules and regulations of the San,.Joaquin Local.Health District. <br /> (Signed)--------------- -------------------- <br /> -----•-- ----------- -- -- ----------------------------------------------._.(0v,,,ef--a44eVor Confractorl <br /> ----------------- <br /> By:-------------------------_Z(---- ---------------- -------- --- ----------------------(Tif le)------- ------------ - - ------- - ----- <br /> - <br /> (Plot plan, showing size of lot, location of system in relation to wells,.buildings, etc., can bre placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-.-. -------� {=----------------- DATE--------- --------------- <br /> REVIEWEDBY--•------------------------------- /------?---------=_----------------------------------------------!------------------ DATE------------------------------------------------------------ <br /> BUILDING PERMIT ISSUED--------------• <br /> i--------------- DATE------------------:------------------------------------------ <br /> ---------------- ------- -4 <br /> s:._ <br /> Alterations and/or recommendation - --------------- --------- -------------------------------------------------------- <br /> ---------------------------------------------------------------------- --------------------------------------------------I-------------------------------I--------------------------------------------------------------------- <br /> - ----------------------------------------------------------------------------------------------------------------:-------------------------------------------- ---------------------------------------------------------------- <br /> ---------------------------------------------------------------------------- ------------------------- ------------------------------------------- ----- -------------------------------------- -------------------- -------- <br /> -------------- ------------------ ------- -- - ------------------------7---------------------------------------------------- ---------------------------------------------------------------------------------------------- <br /> ---------------------------- --------- <br /> FINAL INSPECTION BY: ------- - ------ .,Date--------x--- ------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Harellon AV*. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED B-59 3M 3-63 F.P.013. <br />