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APPLICATION FOR SANITATION PERMIT Permit No. <br /> [Complete in Duplicate] " <br /> Date Issued _/_.�Q-­1,10­7--0 <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 aCounty Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION_��J ._ <br /> Owner's Name-------j-------�',�-{--6-'-- ------------------------------------ ------- -- -----------------. Phone------------------------------------ <br /> Address------------_--`�` �y`�'� ' -.. ....... <br /> Contractor's Name-------------------- r - -- - ----------------------------------•---------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> /y <br /> Number of living units: _�___ Number of bedrooms _•!_ Number of baths __1___ Lot size __�! f <br /> ��Q____________________________ <br /> Water Supply: Public system I?rCommunity system ❑ Private ❑ Depth to Water Table ft. <br /> Character of soil to a depfh of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe &-'Hardpan ❑ <br /> Previous Application Made: Yes ❑ No @R`0New Construction: Yes ❑ No F��'FHA/VA: Yes ❑ No [41" <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> pti Tank: Distance from nearest well-______________Distance from foundation--------------------Material-_____.________________________-----____._,-____. <br /> 1P a <br /> No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- <br /> ispdkal ieEd: Distance from nearest well - -------------Distance from foundation--------------------Distance to nearest lot line___-________:___ <br /> ` Number of lines-----------------------------------Length of each line------------------------------Width of trench-------•--------------------------- <br /> [' Type of fitter material-------------------------Depth of filter material-----------------------Total length------------------------------------------ <br /> Seepage <br /> ______-.____________.___-- _.____Seepage Pit: Distance to nearest well__ srL•_-_'-'_Distance-f orrm undation___ ___.___.D'st nce to nearest lot line_.�.._77 <br /> [�"� Number of pits.-.--/ Lining mial/A��-----Size.Diameter_ J Depth_... f l+ <br /> Cesspool: Distance from nearest well______ istance frorr�fou'ndation--------------.-----Lining material-------------------.___..-------------t}1 <br /> ❑ Size: Diameter-------------------------------------Dep h.-- -------------------------------------Liquid Capacity----------------------------gals., <br /> Privy: Distance from nearest well------------------------------- .---------------_Distance from nearest building----------------------------------------- <br /> , /1 <br /> ❑ Distance to nearest lot line - -----------••-----------------------------------•---------------------------•-------------- <br /> R <br /> Remodeling and/or repairing (describe)__________________ '1 <br /> --- - <br /> -------------------------------------------------------------•--------------------------------•-------------------------------------------------------------------------- S <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 regul ons of the San Joaquin Local Health District. <br /> (Signed)-------•----- — -- - ---- - = -------- - ---------------------------- Contractor) <br /> By:--------------------------------------------- <br /> - --- ----- -----(Title)------ 7 ----------------------_-- <br /> (Plot plan, showing size of lot, Iota of systein relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPD.BY-------- ---- ------ ------- -- ----------------•-------------------- DATE------------ ` J <br /> REVIEWED BY------ ---------------- 2-y-0-L <br /> --- DATEBUILDING PERMIT ISSUED---------------------- --------------------------••--------------------------------------- DATE-------i--------------- ------------------------------------ <br /> Alterations and/or recommendations:----------------------------------------------------------------------------------------•--------------------------•-------------------... <br /> ------------------•---------------------------------- ---------------­_------------------------------------------------------------------------------------------------------------------------I------------ <br /> •------•--------------------------------------•------------.--- - <br /> - ---•-------------- •----------------------------------•------------------------------------------------------------------------- <br /> FINAL INSPECTION BY----------------- ---- --- -------------------------- Date............. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <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 1.57 F.RCO- <br />