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rl APPLICATION FOR SANITATION PEIAMI7 Permit No. <br /> (Complete in Duplicate) <br /> 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 AND L ATION.--- - 1 <br /> .. r� - --- -----------•-•-------------------------- <br /> Owner's Name---------------- - - ------ --------------------------------------------------- ----------- Phone---•-----------------•---------•--- <br /> ---- <br /> Address---------------------- ---- -- <br /> ----------------------•-----------------------•---------------------•----•-------------------------- <br /> Contractor's Name -----� ----- ------- Phone..--------------------------------- <br /> ,Installation will% serve: Residence ❑ Apartment House ®Commercial ❑ Trailer Court [] Motel ❑ Other ❑ i <br /> Number of living units: __-/--_ Number of bedrooms __, - Number of baths _ Lot `________________ <br /> i <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _'weft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[!�Hardpan ❑• I <br /> Previous Application Made: Yes ❑ No RT`_ New Construction: Yes ❑ No FHA/VA: Yes ❑ No [gam' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) # + <br /> , epti Tank: Distance from nearest well-----------------Distance from foundation--------------------Material----_-----___--_------.----.--- <br /> No. of compartments------------ - Size---------------.------------:---Liquid depth---------------------__---Capacity-- <br /> Disp al Field- Distance from nearest well-'Wexteoistance from foundation-,_AQ....-..Distance to nearest lot line---u-17-�__. <br /> ' Number of lines------ ----- ---------- Length of each line_7 ._-__� Width of trench.---_-� <br /> Type of filter material------ _.�rr- - ---Depth of filter material--`4p"--___.Total length____-_ _---------- \ <br /> Seepage Pit: Distance to nearest well- r3•LDistance from foundat•on----1Q---_-- Distance to nearest lot line_ -----_ <br /> I Number of pits_._-_s _____________Lining materia&#_16 : Diameter____?.---.----Depth--.._/2v'S------------------ QS <br /> Cesspool: Distance from nearest well__--------------Distance from foundation--------------------Lining material------------------------------------- "V <br /> ❑ Size: Diameter-------------------------------------Depth-----------------------------------------------------Liquid Capacity-_------------------------gals. <br /> Privy: Distance from nearest well--------------------------------------------._.__Distance from nearest building__---------_-____-------_-_____-------.-. <br /> ❑ Distance to nearest lot line------- <br /> -------------- <br /> ------- -- -------------------•---------------------------------------------------------------------------- <br /> Remodeling and/or repairing {describe}: -----------=•--------------•--------------------- <br /> --------------•-•----------------------•-------- '--- <br /> ----1------------------------------ --------------------------------•------------------------------------------------------------------------ <br /> ------------------------------------ 1 <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 les and regulations of the San Joaquin Local Health District. , <br /> (Signed) -- --'� -- ---. --------------- ------------- Contractor) <br /> -.- <br /> By: -• - ---- ------•-------- -'`* (Title) ,��G(/�i� - ---------- <br /> (Plot plan, showing size of lot, locatio system in relation to wells, buildings, etc., can be placed on revers de). <br /> 4 <br /> FOR DEPARTMENT USE ONLY <br /> ,11MPLIGAT-ION ACCEPTED BY---------------------------- DATE i <br /> _•_•_••---••- ---!-- --- ----------------------- - ------------------- <br /> REVIEWED <br /> -- ----------- - - <br /> REVIEWED BY - ---- - ------------------------------------ DATE ----------� <br /> BUILDING PERMIT ISSUED------------- ----------------------- ------------------------------------ DATE---- <br /> --------- <br /> Alterations and/or recommendations------- ------ ---------------------------------•-------------------:--------------------- <br /> ----------------------------------------- <br /> ----- ---------- <br /> ---------------------------------------- ------------------ <br /> -------------------------------- <br /> ---- ------ ----------- <br /> �. = <br /> ek <br /> --------- <br /> - ------------------ -- - ---- - ------------------------------------------------------------------------ ------- <br /> ------- <br /> FINAL INSPECTION BY:.- ( � <br /> SAN JOAQUIN LOC HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street 9 <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2m Revised 1-57 F.P.CO. <br />