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FO OFFICE US <br /> ----- ---- - ---- = . <br /> /, � � APPLICATION FOR SANITATION PERMIT Permit No. .. `� <br /> ----- - -----• -- --- ------� --- t <br /> (Complete in Duplicate) <br /> 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 County Ordinance No. 549. <br /> I, <br /> JOB ADDRESS AND LO TION -G�b-g ( ---.-----;-----------------••---------------.----------------._---- <br /> Owner's Name <br /> �----" <br /> �_ � ----------------- ---------------- Phone.................................... <br /> Address.----- jv" <br /> - <br /> -- =-----------------------------------------••-•-----------------------------------------•----- <br /> r <br /> Contractor's Name....... -------`-� •--------•--•---•--------•-------------- Phone•- <br /> h Installation will serve: Residence Er Apartment House ❑ Comrierci,al ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: .....t<-_ Number of bedrooms Z- Number of baths .7___. Lot size ---------____•--•_.-------•----•- <br /> 1 <br /> Water Supply: Public system ET—Community system ❑ Private ❑ Depth To Water Table _&e ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ff-Hardpan ❑' <br /> Previous Application Made: (If yes,date....................) No Ir New Construction: Yes Er No ❑ FHA/VA: Yes ❑ No Imo• <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/e__�-•-•_______.Material___I&-�------------••-- <br /> I No. of compartments_.___. --------- Liquid depth_..�_.`________________Capacity__.7!��`_ <br /> Disposal Field: Distance from nearest well-.---------------Distance from foundationl4.r_____.____Distance to nearest lot line___:.... <br /> Number of lines:________i_...___________________Length of each line___ jP-_____-_._________.Width of french.?f:.. <br /> Type of filter material... --_______ Depth of filter material-_h__`-`..........Total length_....`I_?4_f_________------------------ <br /> C�C. <br /> i <br /> Seepage Pit: Distance to nearest well_77.-__-_____.______Distance from foundation_./O---.......Distance to nearest lot line ------ <br /> Number of pits'_/----------------Lining mafiarial--{/i�;�{.------.Size: Diameter----3c?--f,.---.-----._Depth_____ •• ------•-----------••- <br /> Cesspool: Distance from nearest well----------------_Distance from foundation..------------------Lining material--..__._______-_________---_________- <br /> ❑ Size: Diameter.[----------------------- -----------Depth.-------------------••- ----------------------------Liquid Capacity---------------------------gals. <br /> I <br /> Privy: Distance from nearest well--------------------------------- <br /> -------- -------Distance from nearest building------------------------------------------- <br /> ❑ Distance to nea-rest lot line--------- -- -------------------------------------------------------------- ------------------------------------------------- ---------------- <br /> I <br /> Remodelingand/or repairing (describe):--------------------- - -------------- ---------•------------•-------------•---------------••-----•---•----------•--------••---•--------•--•-•----•--•-' <br /> ---­----------------------------------------------------- <br /> -•---•-•------------•- <br /> -------•-•------ -•---------•-----------•----------------• <br /> •-- ------•------------•---------------------------------•-•--------- --- <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 th San J quin Local Health District. <br /> (Signed) ! ._______-------.(Owner and/or Contractor) ?. <br /> ------------ ----- --------- ------- ------------------------------------ <br /> ----•(Title)--------------------------------- <br /> BY:--•----------------•- <br /> (Plot plan, showing size of lot, locatt0 <br /> earn relnti n to wells, buildings, etc., can be placed on reverse side). <br /> r <br /> FOR DEPARTMENT USE ONLY <br /> kBY--"---- �Z' --------------- ---- - DATE----- `�`r e5------ACCEPTED -.-. - -------------------- •�`------ ------ ----------- <br /> REVIEWEDBY--------- ---- ---------------------------------------------- DATE---------_-------------------- <br /> Altera NG PERMIT <br /> Crntions•------- �'�`�' � '----- = .DAT ------------------�(._..---- <br /> . _�_ ......_________ _.�____ A� <br /> ----- <br /> ------------- <br /> Alterations a • <br /> --- -- t <br /> ...............................- ---------------------- ----------------------- ---------- -------------- ------------------------------------------•---------------------• - <br /> ----------•---------•-----•- <br /> FINAL INSPECTION BY:.... ...'' - --------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 245 West 91h Street ` <br /> Stockton,California Lodl,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 2M 5-6Z ATLAS <br />