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FOR OFFICE USE: , <br />--------------------------------------------------------- <br /> 7/ <br /> --------------------------------------- APPLICATION FOR SANITATION PRIAMA. Permit No. . <br /> - -----0------------ (Complete in Duplicate) . <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+he work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION----. <br /> _ - <br />' Owner's Name ----•---- '—' - -•- - --------•-- ------ ----_ Phone---------------- <br /> 0 <br /> Addrass._. L 1.�-��_ __. - <br /> Contractor's Nam es... •---• ..................... -------------- Phone................................... <br /> Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ._., Number of bedrooms _s _.Number of baths __�__�.Lot size ________._�_.,�_.- -_: <br /> Water Supply: Public system ❑ Community system ❑ Private Depth To Water Table _//_ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay LoamPA Clay ❑ Adobe❑ Hardpan ❑ J! <br /> Previous Applicato M&: (If yes,date--------------------) NoA New Construction:' Yes No ❑ FHA/VA: Yes ❑ No,® <br /> q <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) s <br /> ! <br /> Septic Tank: Distance from nearest� well__,l ?.___.-Distance from' foundation------/_P=__-_.Material...._._._ <br /> No, of compartments-------= _..__ ._____Size._..`�.X____-__�___7__Liquid depth___--_-1!............Capacity_... <br /> Disposal Field: Distance from nearest w 1l-/�`._Distance from foundation.- .10�_.__- Distance to nearest lot line___....... l <br /> Number of lines_____________ _ Length of each linea_^_`fs'_ Width of trench___ --`-�_.____ .___ <br /> Type of filter mate:iial�- w-•_Depth of-filter material___ ____ ___/A_____Total length ___ �_`_______________________ <br /> �� g „_, <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- <br /> 0 Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------,Depth---------------------.--------..- <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----------- ........._._._ v" <br /> Distanceto nearest lot line-----------------------------------------------------------------------.----------------................---••-----------------•--_..:...------- � <br /> D <br /> Remodelingand/or repairing (describe):--------------------------------- --------•-•------------------•-•-----•------------------•••---•----•---•---------•-------•----•­­---- ---•-- <br /> -----•--------•-----•---•----------------•-----••--------- <br /> ------------------------------•-•-•---=---•---------------•---•---------------------------•----------------------------------------------•-------•-----------------------•-,•--•------•-•-------- ------ <br /> I hereby certify that I have prepared this application and +hat the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and'reg ulations,.of the,San.-Joaquin Local-Health.District. V <br /> (Signed)-?-( <br /> Signed)--( - -- - -- ---- ------------ ------ 1--------------(Owner and/or Contractor) , <br /> •^i <br /> BY:----------------------------------------------------------------------- ------------------------------------------------------------(Title)- ----------------- ------------------- <br /> (Plot plan, showing sixe of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY 4 r <br /> APPLICATION ACCEPTED BY-------- - - - -=-=-= --- ---- ""'�=: = DATE - <br /> REVIEWEDBY-----------------------_-_•--...------------------------------------------------------------------------------------------ DATE-----------•------ <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------ -------------------------------- DATE,--------•--------------------------------------------------•- <br /> Alterations and/or recommendations: ' Q <br /> _ � <br /> ------------ ---------­-------------- <br /> . <br /> T _ <br /> - -•----. <br /> - r r r. <br /> ------._. Date------ 1 a ?�� ---------------------------------------------- <br /> FINAL INSPECTION BY: ..- <br /> b -� `-r`�--- --- ----• - � <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Strout 300 West Oak Street 124 Sycamore Strout 205 West 9th Street ' <br /> Stockton,California Lodi.-CaUfornia Manteca,California <br /> Tracy,California <br /> ES 9 REVISED 9.59 2M 5.62 ATLAS <br />