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reLICATION FOR SANITATION PEWIT Permit No. ... <br /> (Complete in Duplicate) � •y �q <br /> This Permit Expires 1 Year From Date Issued Date Issued __..... __-___.f <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 /> _ _ C 4 ff <br /> tJOB ADDRESS AND LOCATION______. '__ ____________ _ _ fv --•-- <br /> �y <br /> Owner's Name ` ------.• 1 /1✓! ' 2° - �•i�------------------------ ------- -- Phone..f_l , 3- ~ <br /> Address-------------------------- / 5'f �i /V'&.o L A_r <br /> /20- ----------------------------------------------------------------------------------------------------------•----- ................. <br /> Name-----------------------------------��----��-- z----•�•/uF2-/"1-�!1�-- ------------ <br /> -- Phone................................. <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Co E Motel ❑ Other ❑ <br /> Number of living units: ________ Number of bedrooms ________ Number of baths ______ o size ____.___.____________________________________________ <br /> Water Supply: Public system ❑ Community system ❑ Private ❑ epth to Water Table ________ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay�Loam�d" Clay Adobe D Hardpan ❑ <br /> Previous Application Made: Yes ❑ No ❑ New Construction: Ye 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 /> Septic Tank: Distance from nearest well-----------------Distance from foundation___________________Material------------------------------------------------- <br /> F-1 No. of compartments- ------------------------Size--------------------------------Liquid depth-------------------------Capacity----------------------- <br /> Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line__--_--..---_____ <br /> E] Number of lines-----------------------------------Length of each line------------------------------Width of trench--------------.-------------------- <br /> Type of filter material-------------------------Depth of filter material----------------------.Total length_____.____--__-___--__--___--------____-__ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------Distance to nearest lot line----------------- <br /> Size: Diameter-------------- -- -----Depth--------------------------------- V <br /> ❑ Number of pits__--------------------Lining material----------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation Lining material_______-.__.---_-___.-_ <br /> E❑ Size: Diameter------------------------------ -------Depth----------------------------------- ----------------Liquid Capacity----------------- ----------gals. Q <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building___-_-.___.____________________.__-.__._. <br /> ❑ Distance to nearest lot line------------------------------------------------------------------------------------ -------------------------------------------------------- <br /> Remodeling and/or repairing {describe --------------- ------------------------- -- <br /> /} s SLI <br /> _________________________________________________________ � �__[_y_ ___. ---------------_ d_ /'_______________- _______________________ ---- -----------------------------------_. ____ <br /> ------------------------------------ ---------- --------- L - ---------------------------------------------------- --- ---- <br /> 1 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 the San Joaquin Local Health District. <br /> (Signed)---- ! -- --- --- ---+--------------------------------- -----------------------------------------------------------------(Owner and/or Contractorl <br /> By. - --- --- -------------- -- f-------------------------(Title)--------------------------------------- - ---- ------ -- <br /> (Plot plan, showing `o ot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------------- ------- ----------- ----------------------------------------------- DATE---------- <br /> REVIEWEDBY------------------------------------------- ----------- ---------------------------------------------------------•--- DATE---------------------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------- ------ DATE------------------------------------------------------------- <br /> Alferafionsand/or recommendations------------------- -------------------------------------------------------------------------------•----•--------------------------•---------------------------- <br /> -------------- -- -------------- <br /> ------------------------------- <br /> ---------- <br /> ---- -------- •- ------- <br /> ----------� ------- --------------.-- --------------------- '---------�.n ---------•r`- ------- ----------- ------ ---`-----`---- --------------------- <br /> ---------------------------------------- -- ------------------------- --- <br /> -- - --- --- ------- <br /> t� -t--------------------- --------- __ :__ - .-- -- <br /> /S1 FINAL INSPECTION BY:------------------------ D e - ^-- ---- - ---------------------------------------------------- <br /> SAN JOAQUIN LOCAL HEAL DI T� <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M Revised 8.'59 F.P.Cc. 1� <br />