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APPLICATION FOR SANITATION PERMIT Permit No. ...,1 .�. 7` <br /> (Complete in Duplicate) 3� � <br /> This Permit Expires 1 Year From Date Issued Date .Issued .......___ l0 __4/ <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 /> 0417 <br /> -� <br /> JOB ADDRESS AND LOCATION. --A .........'�{... bu...--- <br /> Owner's Name..... -�� --- ------------------------ Phone--------------------- <br /> - - -- ----------- <br /> b1. --•----•----------------------................ <br /> Address ------rv-------13--------�-�----�f�`_r_----�--------------------- <br /> Contractor's Name--/_ k4_�_.�G.-------------•---------___-•-------------------•-----------------.-_=-------------------•--------__---------------- Phone.................................. <br /> Installation will serve: . Residence I Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _1_____ Number of bedrooms _3___ Number of baths ly_ Lot size _____________________________ <br /> Water Supply: Public system ❑ Community system ❑ Private 00 Depth to Water Tablete_ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam;M Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: Yes ❑ No j New Construction: Yes jo No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATION$,: , <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well_XQ'__--_Dist from from fo ndation----I©,--•_--.Material-- yll� ____-• <br /> No. of compartments_.-�'-----------------Size_7__�t._'r_ 'if -_-___Liquid depth----.-.._._-..-______-Capacity__uz ,.____. �J <br /> Disposal Field: Distance from nearest well%7a _Distance from foundati n__Zd-_________-Distance to nearest lot line_+� ........ <br /> Number of lines 02 Length of each line____%d'._�y__,____.:._.Width of trench-__-aZ <br /> .'t______________ _ <br /> _''______•________________Depth of filter material _ -------------Total length----l0Type of filter materia <br /> Seepage Pit: Distance to n a a ______________________Distance <br /> from foundation................___.Distance to nearest lot line__.________.___._ <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- <br /> Cesspool: Distance from nearest well--------_--------Distance from foundation--------------------Lining material_---_--__-___---.-_-__________-______. <br /> ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity............................ <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------------------------------------._. <br /> ❑ Distance to nearest lot line----------------------------------------------------------------------------------------------------------------------------- <br /> and/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 regulations oft San Joaquin Local Health District. <br /> pro, <br /> (Signed)... 0 . .... 10 --_• -- �' -' ----•----- ---- --------------------(Owner and/or Contractor) <br /> By:.............................................................--- ----- ---- -- -------------------- --•--•---------------(Title)----•- -------- ---- - ----- ----- ----------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> 10, FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- - ---------------------------------------------------------- DATE__c`/m_:4_/----------- <br /> REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE-----------------------------•--------•--------------•------ <br /> BUILDINGPERMIT ISSUED............................------------------------------------------------------------------------ DATE------------------------------------------------------------- <br /> Alterations and/or recommendations. -----------------------------------•---•- ----------••-•-•-----•-•--•---••-------------•••--- •-•---------------------\-•••--- —=- <br /> ............---------- ---------------------------------------------•--------------------------------------------------------------•------------•--------------------------------------•-----•---------------•.--..---•---- <br /> ---------------------------------------------------------------------------------------------- ------------------------------.------------------------------------------------------------- ----- <br /> FINAL INSPECTION BY:L!i`Z%i l ---------------- Date---- Z - '"---------- - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> 4 ES-9-2M Revised 8-'59 F;P.Co <br />