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3 � <br /> 7 - iO C3 APPLICATION FOR SANITATION PERMIT Permit No, <br /> (Complete in Duplicate) <br /> This Permit Expires ] 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. 4 <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS ACATIO ----- _Ylp......._ , <br /> ------ <br /> ---Owner's Name----- . -=---- ----- - Phone--------------- <br /> Address-- - J ----------------------------------------------- <br /> -- --- ----------------------------- --------------------------------• <br /> - - - -- -- ----- Phone----•--------------------- <br /> 1 <br /> Contractor's Name-------------- .............• -------------------------------------------- <br /> Installation will serve: Residence ❑ Apartment House Commercial ❑ Trailer Court E]-., Motel_E],__Other ❑ <br /> Number of living units: ____ Number of bedrooms _ __ Number of baths _ - Lot size ______________________• <br /> Water Supply: Public system Community sysfern [:] Private ❑ Depth to Water Table . ,_z_`ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Va'-'Pardpan ❑ <br /> Previous Application Made: Yes ❑, No�� New Construction::Yes-❑.,,.Na. A-1`FHA/VA1.Yes ❑ No [�}� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within'200 fee"+.)� <br /> Septic Tank:, Distance from nearest well-----------------Distance from foundation--------------------Material------ ------------------------------------------ <br /> N <br /> o. of corn arfinents------------------------- Size_--------------.-------------- <br /> V'11p Liquid depth "_ Capacity... <br /> I <br /> Disposal Field: Distance from nearest-well_______________._Distance from foundation_.......________.___Distance to nearest lot line____=____________ � <br /> Number of lines ,Lngth of each line ' Width of trench •� <br /> Type of filter material----------------_---_-__Depth of filter material____.__=:-*'_.________.Total length________.____________-_.____-__._______. <br /> -� . <br /> Seepage Pit: Distance to nearest well_____"�"",._._Distance from foundation__1�_j___-_.Distance to nearest lot line___CQ.{__.- <br /> ,�,�• Number of its ______Linin material_J40a_--Size: Diameter.-__&P?...___.De Depth ! <br /> 1,<? p g p <br /> Cesspool: Distance from nearest well-----------------Distance from foundation------------------- material------------------------------------- <br /> t.,. <br /> ❑a Size: Diameter---- ---------------------- ----------Depth--------------------------,-------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well----------------"--------------------------------Distance from nearest building <br /> Distance to nearest lot line---------------------------- <br /> . ti j-� � d ----- �. <br /> Remodeling and/or repairing (clescribe) s � ''' <br /> -= -- ----------- ------------------------------------------------------------------ <br /> .a r <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 r es and regulations of the San Joaquin Local Health District. <br /> �- Contract <br /> (Signed)--------------------=-- _ -= .�or or) <br /> BY fysfem <br /> -- - - -------------------- (Title) e� <br /> (Plot plan, showing size of lot, location ofn relation to wells, buildings, etc., can be placed on reverse side). <br /> I <br /> .. FOR DEPARTMENT USE ONLY <br />' APPLICATION ACCEPTED BY-- -- - -------------------------------------------------------------_ ----- DATE------- 1---------------�----------------------- <br /> REVIEWEDBY--------------------------------------------------------------------------------------------------------------------------- DATE------------------------------------- :.---------------- <br /> BUILDINGPERMIT -ISSU'ED-- - �=`='--------------------------------------------------------------------------------- DATE-------------------------------------- <br /> d/ r mmend tions_________________________________________ <br /> ------------- ----------------------=------------------------------------ ----- - - -------- ---------=------------- -------------------------------­: ----------------- <br /> .-- -------- <br /> FINAL INSPECTION BY: _ :: / -¢c- C Date.... 7' ------------------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br />' 130 South American Street 300 West Oak Street ' 132.SycamoreSStreet, S 814 North "C" Street <br /> Stockton, California Lodi, California 'Manteca, Californias Tracy, California <br /> i, ES-9-2M Revised 8-'59 F.P.Co. T <br /> i <br />