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APPLICATION FOR SANITATION PERMIT P / <br /> T ermit No. .....1.._...�.sc,?. <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 LOCATION--• - <br /> - <br /> ---. c <br /> ----------------------------------------------------------------------------•- <br /> Owner's Name___ <br /> __ __ --- ----------- <br /> --------------- Phone <br /> _ _ -------------------------------------------------------- <br /> Address___.-_.-_ -- ------------------------ <br /> Contractor's Name___________________ -- <br /> - - ------- • - - Phone ---------------- <br /> --- --------------------------------------------------------------------------------Installation -will serve: Residence 9 Apartment House ❑ Commercial 0 Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _,/____ Number of bedrooms __,Number of baths ._ Lot size __ <br /> Water Supply: Public system ®community system ❑ Private p Depth to Water Table //94. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Egj-�ardpan ❑ <br /> Previous Application Made: Yes ❑ No 93--New Construction: Yes E] No Z?*'_FHA/VA: Yes ❑ No 2;_ -, <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_-___:_ _ <1�.------.Material---- <br /> No. of compartments------ -_____________ Size_o,�----,X_ Q,y_Liquid depth____ Capacity <br /> j - <br /> �Disposal ield: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line-_______-___.__-. <br /> x��n-1 Number of lines-----------------------------------Length of each line------------------------------Width of trench____________ <br /> Type of filter material__________________ Depth of filter material-___.__----------------------- <br /> length-------------------------- <br /> Seepage Pit: Distance to nearest well--________.-------Distance from foundation__________ Distance to t lli <br /> ❑ Number of Pits----------------------Lining material---------------------- __________ nearest lot-_Size: Diameter-----------------------Depth-------------------------------- <br /> Cesspool: Distance from nearest well_________________Distance from foundation------------.-------Lining material____._-____-_____-_---------__ <br /> ❑ Size: Diameter--------------------------------------Depth----- ------ ------------ - -- --_-___------Liquid Capacity gals. l <br /> Privy: Distance from nearest well <br /> -------------------------------------------.-Distance from nearest buildingr , <br /> `1f <br /> Distance to nearest lot line_____________________________________________ <br /> --------------------------- <br /> Remodeling and/or repairing (describe):__---_-_- �1 <br /> ----- <br /> --- <br /> ---- a <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)------------ - <br /> ------------------ -- --- -------------------------------------------------------- -----(--firCo <br /> C <br /> BY:-------------------------------------•------•--••---- �' tractor) <br /> (Title) �Z - <br /> (Plot plan, showing size of lot, location of stem in relation to wells, buildings, etc., can be placed on reverse side). <br /> -- -� -- <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-----------------------___ DATE10 <br /> REVIEWED BY ---------------- -YA <br /> -- - -------------------------------- ------------------ DATE--------1 D- <br /> BUILDING PERMIT ISSUED ....... <br /> ------------ <br /> ---------------------------------------- <br /> Alterations and/or recommendations:__-_______-__._--____ <br /> ------ DATE <br /> --------------------------- <br /> ---------------------------•--------------------- <br /> ------------------------------------- <br /> ------------- <br /> FINAL INSPECTION BY:_ --------------- <br /> - <br /> Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street <br /> 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California <br /> Tracy, California <br /> ES-9-2,1 Revised 8-'59 F.P,Co. <br />