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FOR OFFICE USE: ' <br /> --________. APPLICATION FOR SANITATION PERMIT Permit No. _..,/................. r <br /> (Complete in Duplicate) <br /> - �---- Date Issued --------..:.�_.Ef z-�' <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. 1 <br /> JOB ADDRESS AND OCATION.. / ..11� -------- yl"- w'?.�'! "-----------------_--------------------_-- <br /> Owner's Name .. -------�1.• -�----- -- Phone.. <br /> Address. ------- -- ------ ----- - ---- ------------------------------------------------------•-•-----------•----------•- <br /> Contractor's Name _ ----•- Phone <br /> Installation will serve: Residence [P Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I <br /> Number of living units: L..... Number of bedrooms 3._._ Number of baths -A-__ Lot size __._ --------------............. <br /> Water Supply: Public system ❑ Community system ❑ Private ® Depth To Water Table .7.0 ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ® Clay ❑ Adobe ❑ Hardpan QJ <br /> Previous Application Made: (If yes,date-------- -----------) No ® New Construction: Yes ® No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: _ _XA <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well. d--------Distance frong foundation_l-A."--------Material--- --_----------------- ' J <br /> No. of compartments----2--_- ---------- -�r�'_• �---6---Liquid depth__._ ------ r '-----------Capacity_� . ....---- + <br /> Disposal Field: Distance from nearest well__ d Distance from foundation__L.�t----------Distance to nearest lot linneX. ........ I <br /> IN Number of lines___._X.... ------._._. Length of each line__./.�..-...._......Width of trench....;'.y--11--------------------- <br /> Type of filter material Depth of filter material----1 f. ..........Total length..sA'_&P........................... <br /> Seepage Pit: Distance to nearest w'I- e"1 __1_....--Distance romf oundation._-f 47......_._.Distance to nearest lot line-----__....... <br /> Number of pits--o2----------- ----Lining material f:�/�--_-------Size: Diameter---.33-��..._.--..-Depth-�S�..._...._____._------ <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 /> Remodeling and/or repairing (describe)--------------------------------------- ------------------------'--` -•-_---------------_- ---•----------------------------••--------- <br /> w +-r f }. <br /> ---•-•-------------------•------_-....---•-------•-----------------.---------------------------------WWW---_--`-------------- --------------•--•-•------------------- -----------•-------•--•--------------------------- pd <br /> ---------------------------------------...------------•-----_-. ----------------------W-- -- <br /> --------------------------------------- ----•----------------------- ------ •------------------- � <br /> I hereby certify that 1 have prepared this application and that the work will be'do`ni3 in a�cordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health-Distric+. <br /> (Signed} --- � --------------------------- ---------- ----- -.(Owner and/or Contractor) <br /> BY:--------------------•--•------------------------ ---- --------------------- -- <br /> - ---------------------`--------- _-•-------- ----••-•---------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can'be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- -------- -- - ---------­­-- ---------------------•------------------------------------- DATE---1 "" 1' �A'L ---- ----------------- <br /> REVIEWEDBY-------•------------------------------------- --------------------------------------------------------•--•- •---------------- DATE---------------------------------------------•---•---------- <br /> BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------.- DATE--------- ---------------------------- ----------- <br /> Alterationsand/or recommendations:------------------ --------- ----------------_------........ --------------------------------------------------------------_--.---------------------- <br /> •---------------...............................•-------------------------------------------------------------------------_----------------- <br /> FINAL INSPECTION BY: .t s.r ------ --------------- Date..,?....�.. ------ ---------------------- -- _------------------- <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 8-59 2M 5-42 ATLAS <br />