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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> 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 in all the work herein described. <br /> This-application is made in compliance with County Ordinance No. 549. <br /> ��1 OOA r <br /> JOB ADDRESS AND LOCATION-------------- ot a, �� 4 1A_': _ ... <br /> Owner's Name----- - : -'�. •--------•------------ -------- --- --- ------- -------------- ------ Phone------------------------------------ <br /> 1102 PAvil!10 <br /> _.-_-------- --------------------- <br /> v0 AVO,* <br /> Address-----------------------------------------------------------------------------------------------------------------------------------------------------------------------•-•---------------------.............. <br /> Contractor's Name _ -- i# Phone _. #----- <br /> Installation will serve: Residence rA Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units ,_ Number of bedrooms __-: :- Number of baths _---. . Lot size €__ .._1.35--------------------------_-- <br /> Water <br /> ___---•___ ---_-.---. ..._Water Supply: Public system ❑ Community system [:I' Private ❑ Depth to Water Table _--0 ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe'[[_T Hardpan ❑ <br /> Previous Application Made: Yes ❑ No a New Construction: Yes R No ❑ FHA/VA: Yes No ❑ <br /> t <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well '' ____Distance from foundation . : __-_Material ___ `1 44. --_ __-_. <br /> ft <br /> No. of compartments_._-_- _ __Size_____ ? __ -- ___Liquid depth_--_ . _-. _Capacity_- . .-_--------- <br /> Disposal Field: Distance from nearest well----.. ------Distance from foundation-e _______.Distance to nearest to line_-_-24 <br /> Lit, Number of lines74 <br /> _ �: __Length of each line__--_ � Width of trench _--_- <br /> Type of filter material-A. _Depth of filter material _..____ __..Total length___ �'---------­------------------ <br /> 1 <br /> Seepage Pit: Distance to nearest well It _---._--___Distance from foundation ;Distance to nearest lot line •-�= <br /> r .-_____._Size. Dmeter 106114 <br /> Number of pi.ts_. _..__.. __ Lining material_ _ � : . ... .____.Depth _ _' .......... --J <br /> Cesspool: Distance from nearest-well------------------Distance from foundation--------------------Lining material-------------------------------------- „JV <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):_-_-_-.-. _-__. _ <br /> ----•------------------------------------------------------------------------------------------•----------------------•------•--------------------------------------------------------------•------------•------------------- <br /> --------------------------------- ------------------ ----------------•----------•-------------------------------------------------------------------------------------------------------------------------------------- <br /> ti <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 of the San Joaquin Local Health District. + <br /> (Signed) .. _ -- ------------------ --------(Owner and/or Contractor) <br /> By:-------------------------------------------------------- ----- ---(Title)--- " <br /> (Plot plan, showing size of lot, location of system ' elation to wells, buildings, 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 /> Alterations and/or recommendations: - = --------------------------------------- <br /> • ------ <br /> ----- <br /> �'� ------- "----- a ---- <br /> ------------------------------- -�----- <br /> ----------------------------------------------------------------------------------------------------------- ------------------------------------------------------ ----------------------------------- -------------------- <br /> FINAL INSPECTION BY:---- - Date--- _- - —----------------------- ------ l <br /> 1 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 4 <br /> ES-9-2M Revised 8-'59 F.P.Co. 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