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FOWOFFI E E <br /> :_ ----__-_-- APPLICATION FOR SANITATION PERMIT Permit NO. .241...;-, <br /> - (Complete in Duplicate) �> <br /> ------------------- <br /> ---------------- This Permit Expires 1 Year From Date Issued <br /> 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 OCATIOt�I, ..7 _ ---------------------r . .... ---•------------------------------------•---------•---- <br /> Owner's Name �. ............................................------------------------------------------------------------------------ Phone <br /> Address .. .. 7 . <br /> .... --•-• ----------------------------------------•----------•------•---------•-•----....-----•-••-------............----••-•-----•-•• <br /> Contractor's Name.. ........ s........................................ ----•--•--- Phone.............................. <br /> Installation will serve: Residence [2" Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: ----'• Number of bedrooms -_3_. Number of baths lk Lot size .... J4....................................... <br /> Water Supply: Public system ❑ Community system ❑ Private [B/tepth to Water Table .4,9. ft. <br /> Character of soil to a depth of 3 feet: Send ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: (If yes,date------_-------------) No e New Construction: Yes [5'—No ❑ FHA/VA: Yes ❑ No 25' <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.-P--_------Distance from foundation-_--1 ..............Material... +?!... ........................ <br /> No. of compartments-------�.............Size.......* '�. Z.Liquid depth........ ` .........Capacity.....8 <br /> Disposal <br /> : Distance from nearest well Distance from foundation....................Distance to nearest lot line. <br /> / Number of lines-----------------------------------Length of each line------------------------------Width of trench................................ <br /> Type of filter material.........................Depth of filter material-----------------------Total length.........................................- <br /> Seepag� Pit: Distance to nearest well_/_QC_�......_..__.Distance om foundation �.�..-.-..._..Distance to nearest lot line '�U....... <br /> 19, Number of pits......... Lining material-- -------Size: Diameter....3 ..........Depth..........aa.1 ........... <br /> Cesspool: Distance from nearest well.................Distance 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 /> I hereby certify that I have prepared this appl' tion and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations the an Jo quin Local Health District. <br /> (Signed)................................................-••----•------ --••• - ------------ -•---•-•--•----•--•--•••--••-•••-••--•-------•--•------••--•---••--.(Owner and/or Contractor) <br /> By:.................................................... •-- . •---- ...... -•---..----------------------------------------(Title)--------------------------------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relati to wells, buildings, etc., can be placed on reverse side). <br /> R DEP RTMENT SE ONLY <br /> APPLICATION ACCEPTED BY-__ ), .— _-___-_.. DATE....... <br /> REVIEWEDBY................................. --••••---------------------•----...-------------•----------------------. ............ DATE------------------------------------------------------------ <br /> Z PERMIT ISSUED...... •-•--••--•--•---•• ••-----•----. DATE--- -----------•; <br /> Alterations and/or recommendations•_. !— .,c ..:�.c.7 ... .. . <br /> .-•--- ------•--•.•.........................................-••••------ <br /> ,0 1 <br /> f. <br /> FINAL INSPECTION BY: :. <br /> Date-------- <br /> 'FINAL INSPECTION B <br /> Y- ` <br /> 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 /> ES 9 REVISED 6-59 2M 6-61 ATLAS <br />