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FOR OFFICE USE: <br /> 1 ------------ 7.7 3 <br />--------------------------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. ...1. <br /> ------------------------- ------ (Complete in Duplicate) Date Issued------------- ----------------------------------------------_.--__---- 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. <br /> JOB ADDRESS AN CATIO ---I 1 Z2------- 7 - ----- ------------------- <br /> Name --------------- - Phone----:-------•-----_-------------- <br /> Owner's N <br /> - ----- <br /> Address-----1 •---------------•----------------•-----------•--•----------••------------- <br /> Contractor's Name------------------------------------- Phone. <br /> -------------- <br /> �� ------------------ <br /> ---------------------- ------------------------ <br /> -----­---------- <br /> Contractor's <br /> will serve: Residence [�Apartmenf House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: C�- Number of bedrooms 2- Number of'baths _ Lot size __(� _tr- i ------••-----•-------• •- <br /> Water Supply: Public system E<6ommunity system ❑ Private ❑ Depth to Water Table S-V ft. <br /> Character of soil to a depthof3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe gR--<ardpan ❑ <br /> If y <br /> I <br /> Previous Application Made: es,dated_q�;-]......-1 No ❑ New Construction: Yes El No FHA/VA: Yes [:] No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> *(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> k: Distance from nearest well_________________Distance from foundation___-_____-._______Material__-_.____-_-__-______-_____-_...__.______._____- <br /> No. of compartments--------------------------Size-------- ----------------------Liquid depth---•----------------- --Capacity----------------------- <br /> 1,Field: Distance from nearest well---------------.-Distance from foundation--------------------Distance to nearest lot line___._______....._ <br /> Number of lines---------------------- ------------Length of each line------------------------------Width of trench.-------.-----.--------------------- %J <br /> Type of filter material-_______________ ________Depth of filter material______________--_____.Total length________._______-_____-___.-______-`____ S <br /> r <br /> Tom- Distant m undation__ f ___.______.D scarce to nearest lot <br /> -;6:f it: Distance to nearest well--/!-{1 - -- <br /> Number of pits______-.__.___---Lining material_ x. --.Size. Diameter ------- ----------•--- <br /> Cesspool: Distance from nearest well-------------- from foundation-------------------lining material-------------------------------------- <br /> 0 Size: Diameter--------------------------------------Depth----•--------------------------------------•---:----Liquid Capacity- -------------------.-----•gals. <br /> Privy: Distance from nearest well-______________________-.----------------------Distance from nearest building----------------------------------------- <br /> nDistance to nearest lot line-------------- -------•----------------------------------------------------------- ------------------------------•- --------•------ <br /> Remodeling and/or repairing (describe):--------------------------------- ----------------------------------------------------------------•------••--------•-----------------------------••---- <br /> --------------------------------•---------------- <br /> ----------------- <br /> ----- - ----------------------------- ----=-••------------------------------------=----------------------------------------------------------------------------------------------------------- <br /> I hereb , er 'fy that I have prepared this-application and that the work will be done in accordance with-San Joaquin County <br /> ordinances, at laws,a'11n rulesSad regulations of the San Joaquin Local Health District. <br /> -- Owner and/or Contractor) <br /> (Signed)----- ----- �r ...... <br /> ------ <br /> Title <br /> (plot plan, showing size of lot, location of system in relation to wells, buil ngs, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> `." -------- DATE--- r <br /> APPLICATION ACCEPTED BY--- ------ ------------------------ { <br /> REVIEWEDBY-------------------------- ------- - ---------------- -- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED-------------------------------------------------------------- ---------------------• • DATE--------------------------__------------------------------ <br /> Alterations <br /> - ------------------------------- <br /> Alterations and/or recommendations----------------------- --- -------------------------------------------------------------••-------------------------_-------------•------- <br /> ---------------------------------------------------------------------------------------------------------- <br /> - <br /> t Y = ---------------------------- <br /> ------------------------------•--------------------- <br /> -----------------11------- <br /> • �f ----- Date_- ...... lr--------------------- ----- <br /> FINAL INSPECTION <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 13.59 F.P.CD.2M 6.5D <br />