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FOR OFFICE USE: <br /> ------------------- ---- <br /> ' <br /> --- o APPLICATION FOR SANITATION PERMIT Permit No. .............. <br /> - (Complete in Duplicate) <br /> __ Date Issued .1- <br /> -------------- This-�2 1t7 This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San 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 O ATIO .. Q,� /}--� � <br /> -'-------'--'Ir '- ........... e_..__ ._---._.[!\.it.Al/_.---•------•--•-------...•...................•..........._...... <br /> Owner's Name4 Phone <br /> l ----•- <br /> Address---••--------•-•--•--•-•-------•-•---•---•-•-------- <br /> Contractor's Name................................-• -- ... -_... ........................................................ Phone................................... <br /> Installation will serve?—Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑. <br /> Number of living units: _._...__ mber of bedrooms ._V-. Number of baths a'__ Lot size ..... .-_x....�_ - <br /> --- -----•------------ <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table .6c5l_ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy-Loam ❑ Clay Loam ❑ Clay ❑ Adobe[2-- aardpan C]Previous Application Made: (If yes,date--------------------) No New Construction: Yes E] No HA/VA: Yes E] No E; <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank; r Distance from nearest well-----------------Distance from foundation....................Material................................................. <br /> No. of compartments--------------------------Size............................---•Liquid depth--------------------------Capacity....................... <br /> Disposal Fiel : Distance from nearest well-________________Distance from foundation....................Distance to nearest lot line................. <br /> umber of lines-----------------------------------Length of each line--_---=---------------------Width of french................................... <br /> Type of filter material-------------------------Depth of filter material..'!­.---------------Total length........................_................. <br /> Seep_�aagge��e}}-- Distance to nearest well----------^- ---------Distance from foundation:_ -O-...'.---.Dista to nearest lot line. �..._.. <br /> �� �4 7 Number of pits-- ----I-------------Lining material=�jo-c-�----Size: Diameter--- ��_Depth----- <br /> Cesspool: Distance from nearest well-----------------Distance from foundationnc-------------------Lining material_.___..__.._.•.____.___..._........_. <br /> ❑ Size: Diameter-- -- ---- ------Depth-------•---_---- -- ------Liquid Capacity -----•-- -- •----.-gals. <br /> Privy: Distance from nearest well ------------------------------------------------Distance from nearest building.......................................... <br /> ❑ Distance to nearest lot line-----------•---------------•---.------------- <br /> Remodeling and/or repairing (describe):---- ------1- -•--&& --------------------•-----•-----------------------•--•-•-•--..---..........>... <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, St laws, and rules and regulation,-,of the San Joaquin Local Health District. <br /> (Signed)------------'�F---A ----------------------------------------(Owner and/or Contractor) <br /> F ----- <br /> BY: �J 1 1�-1.X1 -- --------- (Title)_._. ---U - ------------- <br /> (Plot <br /> plan, showing size of I , location of system in relation to wells bw ins bI <br /> Y g , etc. can e paced on reverse side). <br /> FORDEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY... _ - - DATE.. Z <br /> ".. ----- <br /> REVIEWEDBY---- ----------- ----------------- ----- ................................. DATE----------------------- <br /> BUILDING PERMIT ISSUED--------------..........................................._---------------— <br /> ------------ <br /> ..................... DATE. <br /> t ,Alterations an /or recommend ns------------------- ---- ... - - <br /> ....... _ <br /> G- <br /> ---- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------ <br /> _-----------' <br /> FINAL INSPECTION BY:.--- ../...... ------------------------ <br /> Data....)J <br /> Vf SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> E■•9 REVISED 9-69 F.P.OD.2M 6.60 <br />