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FOR OFFICE USE: <br /> - ---- ----- -------- <br /> ------------- --------S71>---------- R'APPLICATION FOR SANITATION PERMIT Permit No. <br /> ----------- ---------------- (Complete in Duplicate) Date Issued --- <br /> -------------- ------------------ 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 fCATION........... .................................................. <br /> Owner's Name---------a ........ ...... -------------- ---------------7-------------------- Phone.................................... <br /> _- /. .-�-- <br /> ................................................................................................ <br /> Address............................................... --- ---------- .........C� ------- <br /> Contractor's Name....................... . ..... - ----------------------------------------------........................................... Phone................................... <br /> Installation will serve: Residence4a---A—partment House E] Commercial [] Trailer Court [-] Motel 0 Other [I <br /> Number of living units: I--___ Number of bedrooms ---Z Number of baths /.... Lot size .....U_, ---)�/Qx---—------------ <br /> Water Supply: Public system 91"C-ommunity system [-] Private [-] Depth TO Water Table 4�t- <br /> Character of soil to a depth of 3 feet: Sand [] Gravel [] Sandy Loam [] Clay Loam C] Clay 0 Adobe 2--Fra-rdpan 0 <br /> Previous Application Made: (if yes,date--------------------) No VeNew Construction: Yes [B-o E] FHA/VA: Yes E] No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic > Distance from nearest well.....----.Distance from foundation---/_4...�.--.Mate,ial--- ............. <br /> Isa iz:��------ <br /> e No. of compartments-------- ---------------Size---- Liquid depth-.-.�a-—---------Capacity.....e-j6?.- <br /> 10-- <br /> Disposal ielcl: Distance from nearest well--- Distance from founclation-,,ol.4.../.....Distance to nearest lot line-.%.Y-2�.... <br /> ./e ------- <br /> OK Number of lines......... -------------------Length of each line..... ....._.Width of trench.,=.Z.,V.�,............... <br /> Type of filter material....�'0-4 <------Depth of filter material ....Z.....Total length.......�;; ../.................... <br /> See Distance to nearest well__- ----Distance from foundation---/,I /....Distance to nearest lot line...._. <br /> Seep <br /> t Number of pits--------- ----------Lining materiat-Y-VCk-------Size: Diameter--J--?'/r---------Depth---- ............. <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-------------------Lining material...._........._..............._...... <br /> 0 Size: Diameter--------------------------------------Depth----------------------------- ------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well----------------------------------------- -------Distance from nearest building-____--__--_____-___-_____--_._-_-.__-_.-. <br /> ❑ <br /> uilding------------------------------------------ <br /> 11 Distance to nearest lot line------ --------------------------------------------------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):-------------------- ---?_,a�------- . ...... ... ............ <br /> .................................................................. ------------------------------------------------------------------------------------------------... ----------------------------------------- <br /> ---------------------------------------------------------------.............................................................................................................................................................. <br /> ......................•----------------•------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> I hereby certify that I have repared this application and that the work will be done in accordance with San Joaquin Co6nty <br /> 1 <br /> 4an reg on <br /> ordinances, State law, and r �-- and of the San Joaquin Local Health District. <br /> .......... <br /> (Signed)--------------------------/--- ------ ----- ---- ------------------------------------------------------�;�---(Owner and/or Contractor) <br /> ---- ------ ------------------- <br /> By:----------------------------------------------- --- ------- ----------------------------(Title)----------- e--- <br /> (Plot plan, showing size of lot, locao of system in relation to we , buildings, etc., can be placed on reverse side). <br /> Z * <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------4- ----- <br /> ------------------ <br /> /- / - <br /> REVIEWEDBY---------------------------------------- ------ --------------------------------------------------------------------------- DATE............................................................ <br /> BUILDINGPERMIT ISSUED------------------------- ---------------- ----- ------------------------------------------------- DATE-------------------, --------------------------------------- <br /> Alterations an ---------------------- -a------------- .... .. <br /> /or recommeocrations: 7-t-t—r -C- <br /> o <br /> ----- —------ <br /> ............. 2------ ------- --------------- ..... ..... . ...-F._ . ........... <br /> ......................................................................... -------- ........................................................................................................................................ <br /> ..................................................................... --------------------------------------- ............................................................................. ................................. <br /> -------------------------------------------- ----- ---------------------------------------I--------------------------------------------------------------------------------------------------------------------------........ <br /> FINAL INSPECTION BY:...Al fl q-------------------------- <br /> --------- --- ------------------------------------- Date-------- ..... <br /> 6- -- <br /> kox <br /> rSAN 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 /> ES 9 REVISED 8-59 2M 5-62 ATLAS <br />