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FOR OFFICE U#: <br /> JJ <br /> APPLICATION FOR SANITATION PERMIT Permit No. .., <br /> -------- --------------- - - - (Complete in Duplicate) <br /> A—--------�_.­ I This Permit Expires 1 Year From Date Issued 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 D LQCATION0� ---------- <br /> Owner's Name `S .'t . <br /> Pho .. ......�1KIz <br /> Address------R 7-- �r <br /> f -------------------------------------------------------------- --------------•--------------------------------------------- <br /> Contractor's Name olLPhone-./ .-/.. <br /> Installation will serve: Residence [ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ....-- Number of bedrooms ._X_ Number of baths -1----- Lot size .... ................................... <br /> Water Supply: Public system g?r' Community system ❑ Private.❑ Depth To Water Table kq. ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ff"ardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No Eff" New Construction: Yes 2"'No ❑ FHA/VA: Yes 4❑'" No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) p e&v, <br /> Se ank: Distance nearest well--:r= <br /> -----'-Distance from foundatin / _ �r ___---- Liquid depth_ ,��-------Capacity--- -�c- <br /> eNoof compartments === <br /> Disposal <br /> Field: Distance from nearest well_.____ -------Distance from foun atior/O----------------Distance to nearest lot line................ <br /> [� Number of lines_______I___?________________________l-ength of each line.....�.l3_______..........Width of trench.,��!'.._....................... <br /> Type of filter material'7P(_A------------Depth of filter material---�_8'__--------Total length.....CA.r................. <br /> 1 <br /> Seepage:Pit: Distance to near well ___ _____________Distanc om foundation__�b............Distance to nearest lot line._C'5....�.._.... <br /> Number of pits_ ___-__.__Lining material-____Q.C- -----Size: Diameter___32. ................... <br /> Cesspool: Distance from nearest well----------------- from foundation--------------------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 /> Remodelingand/or repairing (describe):--------------------------------- ---- ------------------------------------------------------------------------------------------------------------------ <br /> -•.-----.-•---•---•----••••--•--------•..-•-•--..--•------------------•--------•- .------.----------------.---------------------------------------------.---------------------..-----.-----.-•-------.-.----------------.----- <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 re ations of the n Joaquin Local Health District. <br /> (Signed)-----------------------------------------------....--- -------- ----------- ----- .-�!`J ------------ -T-°�---�' (�r Contractor) <br /> BY: f =-- --- --------------- -------- ------------(Title) -- <br /> (Plot plan, showing size of lot, location of system in relation toell dings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- ----- -- ---------------------------------------- DATE------ <br /> REVIEWEDBY----- ------------------------------------ ------------------------ ------------------------------------------------------- DATE........................................................... <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------(-------------------------------. ...... DATE------------------------ <br /> - � �- ....... <br /> ,-.- -- <br /> - <br /> Alter tions nd/or r ommenclations ----,<.- `- _ '..�.......... .........' � -------------- - - - ---------------------- -- --- <br /> ----------------------- -------------------...----•--------------------------------------------------....----•-•----•-----------------•-•-•-•---••----------•-•--•----••----•-------------•-----•------•-......- <br /> ------------------------------------ -------------------------------------------------- --------------­------------------------------------- ----------...•--•-•-•----•-------------------------•-•-------•--••----•--- <br /> FINAL INSPECTION BY:. "t, <br /> F ... -- ---------- Date------------------------------------------------------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Strout 300 West Oak Street 124 Sycamore Strout 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 2M 5-62 ATLAS <br /> c <br />