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U .�y <br /> APPLICATION FOR.,SANITATION PERMIT Permit No. .. - A-__ <br /> A '(Campl®#e in Duplicate) <br /> This permit. Ex ire3 1 Year From Date Issued Date Issued 4_4'1)__ <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 rdinance No. 549. <br /> f. JOB ADDRESS Ar L ATION______� 6J-___ ___ _ _,-_-- <br /> --Own ---------------------------------------------------- <br /> Owner's <br /> er's Name- ------------------------- ------- --------:--------------------------------------------------------- ------ - Phone------------------------------------ <br /> Address----------------------- 5 �`x'••--��'r•-••b <br /> --- •--------------------------------------- <br /> Contractor's Name-------------- --------- ----------------- Phone----------------- <br /> ' Installation will serve: Residence 7❑--A-rpartment House ❑ Commercial ❑ Trailer Court ❑ - Motel ❑ Other ❑ <br /> Number of living units: __/__ Number of bedrooms _.o9-- Number of baths __/__ Lot size --- -- _�_//4_ -� <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Wafer Table _/,A ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2 Hardpan ❑ <br /> 3 Previous Application Made: Yes ❑ No �New Construction: Yes Za---No ❑ FHA/VA: Yes P-­50 ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f <br /> i ` <br /> _ __________.Material__ _/../__.. _'_ •_ <br /> Septic Tank: Distance from nearest well_ �______Distance,fyom foundation----ri� _ ._________. <br /> . Dis os�al Field: Distance from nearest well__ Size_��.�__���.__.Liquid depth --- ___� � Capacity----���___ <br /> No. of compartments....__.___ <br /> p �._Distance from foundatio �..9.1i� f_____Distance to nearest lot line________ <br /> ®� Number of lines-_-..-._./-____P.______.__ Length of each line------Y.Li_� _ Width of trench �r� _________________ <br /> Type of filter material___�_�,) �/ Depth of filter material___._1`f _..____Total length_____.__ p-_________________________ O <br /> Seepage it: Distance to nearest well__lr�______Distance fr ``fo�undation____ -_.-___.D;�tanOOe nearest lot line___a.. <br /> Number of pifs._____�_______-___Lining material--- _e��_.Size: Diameter___, _-- Depth----1.0 !______. <br /> Cesspool: Distanca from nearest well-------_---------Distance from foundation_,-------------------Lining material----_-----------.----------------.-.-. t! ' <br /> ❑ Size: Diameter-------------- -------------1I-------..Depth-----------------------------------------------------Liquid Capacity_--------------------------gals. <br /> Privy: Distance from nearest well-------1-----------------------------------------Distance from nearest building-------------_________________________... <br /> ❑ Distance to nearest lot line -------------- <br /> i 4. <br /> `.; Remodeling and/or repairi^g describe):- �.r/! _ 1.. <br /> --------------•--------------------------------------------------------------------------------------------------------------------7-----------=------------------------------•-------------------------------------- <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 rilles and regulations of the San Joaquin Local Health District. <br /> (Signed)-------------------- -:---- ---- ��Ff = = ------------------------ -I�r Contractor) <br /> By=----------------------------------------------------------- ----- - ------ .----- - -------------------------(Title)--------- �� ...... -------- <br /> (Plot plan, showing size of lot, location of sy ii:relation-to wells,-buildings,.etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> P <br /> APPLICATION ACCEPTED BY----.--- DATE--- ----- ,I --- -- -------------------- <br /> REVIEWEDBY------------------------------------ -------- -- - ----- ------------I------------------------------------------------------ DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED--------------------------------------- ----------------------—------------------------------`------. DATE------------------------------------------------------------- <br /> Alferafions. and/or recommendations-----------------------1-----------------------------------------------------------•----------------------------------------------•---------------------------- <br /> -------------------- -------------------------------------------------- --------- ----------------------------•---------------------------------------------------------------•--------------------------------------- <br /> ------------------------------------------------I----------I-------- -------- ------ ------------- -= -----------==---= _=�----•--------------•-- ----------------------------------------------------- <br /> .------- - - --- ---------------------------------------------------------------------------------- ------------------------------------------------------------------------------ ---------------------------------- <br /> --------------------------------- -----------------------------------._­------------------------------------- -------------------------------------------------------------------------------------------- <br /> E FINAL INSPECTION BY:. - - --------------- Date----...--- � G ------ ---------------- <br /> SAN JOAQUIN'LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak S#eet 132 Sycamore Street. $14 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> a <br /> } ES-9-2M Revised 8-'59 F.P.Co. J1 <br />