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FOR OFFICE VSE: <br /> APPLICATION FOR SANITATION PERMIT Permit No. ..... ....... ...... <br /> -------------------------------- ---------------- <br />----------------------------- --------------------- (Complete in Duplicate) <br />--------------------- -----------I---------------------- This Permit Expires I 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. <br /> This application is made in compliance with Cou ty Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION--.�gt�-------Z, --- ------------------------------------------------------------------------------------- <br /> Owner's Name.. ._ <br /> ......... -z-- - ............ Phone.................................... <br /> Address---------------- ... .... .... .........Pi... <br /> Contractor's Name.... __:.*A-....f... ........................................................................................... Phone......._.....---.........._..--.... <br /> Installation will serve: Residence 2'-'Apartment House [] Commercial 0 Trailer Court 0 Motel 0 Other [3 <br /> Number of living units: Number of bedrooms -__2-Number of baths ...1.__ Lot size .....,173--Y_-..I., ..2 L. ................... <br /> Water Supply: Public system [Community system [] Private E] Depth to Water Table ./o?ft. <br /> Character of soil 4*-a depth of 3 feet: Sand [:] Gravel E] Sandy Loam [-] Clay Loam 0 Clay [Adobe 0 Hardpan 0 <br /> Previous Application Made: (If yes,date_________________-_) No [J 'New Construction: Yes U?-Iqo [] FHA/VA: Yes <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> S,-,p an Distance from nearest well-----------------Distance from foundation--------------------Material................................................. <br /> T6�� I <br /> No. <br /> of compartments--------------------------Size................................Liquid clepth--------------------------Capacity....................... <br /> Di odd Distance from nearest well.-_-!!!�k----...Distance from foundation...01-..........Distance to nearest lot line-Ar......... <br /> If Number of lines........I-------------------------Length of each line-.,,.3-,O................Width of trench----A.*.................... <br /> Type of filter maferial.1.0-Clir---------Depth of filter material---/-*__°:.____..__Total length........10---�...................... <br /> Seepage Pit: Distance to nearest well-------:__-_-_____Distance Distance from founclation-140............Distance to nearest lot line.. ......... <br /> D" Number of pits--------i............Lining material.._7-6,4.4 A---Size: Diameter-------3-2.........Depth...ZJ................ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material............._..____........_.._..._. <br /> ID Size: Diameter.-------------------------------------Depth----------------------------------------------------Liquid Capacity............................gals. <br /> Privy: Distance from nearest well------------------------------------------------Distance from nearest building.................._..........._......__._. <br /> 0 Distance to nearest"lot line-----------------------------------------------------------------------............-----...._..--------------------•-----•----•-•------•-- <br /> Remodeling and/or repairing (describe)------- ----------------------------- ............................................................................................................... <br /> ............................................................................................................................................................................................................................. <br /> .....................................................................................................................................--..................................................................................... <br /> ........................-----------------------------------I---------------------------------------------------------------------------------------------------------------------------------------------.................. <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 andiregula ions of the San Joaquin Local Health District. <br /> (Signed)............................................ ... ..... ............ ---------------------------(Owner and/or Contractor) <br /> .... ..... .... <br /> By:......................... ............ -- ----------------------------------------------------------------------(rifle)................ --------------------------------------- <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 /> V <br /> APPLICATION ACCEPTED BY------- ----ft-----, ---- ---- ............................ DATE------ 7.—..... ---C0....------6 <br /> REVIEWED <br /> .....6 <br /> REVIEWED BY................................................ ---------------------------------------------------------------------- DATE........................................... <br /> .............................. <br /> BUILDINGPERMIT ISSUED--------------------------------------------------------------....................................... DATE----------------------------------------------- •----------- <br /> Alterations and/or recommendations:--------------------- ------------ <br /> ---------�v <br /> ------------- <br /> -7 <br /> --- ---------- . ...........C.... ............................ <br /> ........... ... <br /> ........................... ........................................................................................... ............................................... .................................... <br /> ............................................................................................................................... ............................................................. ......................... <br /> ................................ ........... --------------------- ••---------------------------------- .................................................................................................................. <br /> ----------------------- Date...... .................... -------V..................... <br /> FINAL INSPECTION BY:....6-�,------ <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 5-61 ATLAS <br />