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, [ I,--- <br /> - <br /> < <f <br /> } --------------1/t_:�V APPLICATION FOR SANITATION PERMIT Permit No. .,< �— <br /> ---------------------- ------------------------------ (Complete in Duplicate) <br /> ------------------------ ---------------- -- - -- ° This Permit Ex ires 1 Year From Date Issued Data 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 Ordinancffl No 549. <br /> JOB ADDRESS AND LOCATION <br /> ----------•--------•-----------•--••---------------------------------------------------------------- <br /> e <br /> ------•- -- ------•-•----- ------•------------ <br /> Owner's Name --�±--� '- <br /> -----•-------------------------------------------- ------ Phone--- <br />,. Address -•-• - <br /> Contractor's Name________________ _ ___ �?,.-:` j <br /> -------------------•------------•-------------••-----------..---------- <br /> Installation will serve: Residence (Apartment House ❑ Commercial Trailer <br /> ' - ❑ Court Motel 0 Other El <br /> Number of living __units: �___ Number of bedrooms _ _ Number of baths _ -__ Lot size l -r ---l4. • <br /> Water Supply: Public system Community system ❑ Private ❑ Depth To Water Table J65p ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Ra"TH—ardpan ❑ <br /> Previous Application Made: (if yes,date------------------._) No New Construction: Yes ❑ No FHA/VA: Yes ®r 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_f� <br /> y --------- <br /> i -----•----- -- <br /> No. of compartments------�.__ ----Size_�� X �j!--------_--Li-_Liquid de th__�f.___--- Ca aci <br /> q P ---•---• P tYQ <br /> Disposal Field: Distance from neare�well----^ Distance from founclation...f4..-____..._Distance to nearest lot line... w <br /> g Number of lines___________------------------___ Length of each line_._.__ p , <br /> / -- - Width of french__.;P---,,, <br /> "S <br /> of filter material.11_/�P :-Depth of filter material____-.� ��-__.-Total length__-____� ............................ <br /> Seepage Pit: Distance to nearest`well-------- Distaste from foundation__ P_�____. <br /> �Dis�ance to nearest lot fine.__s�' ......... <br /> Number of pits----I:_/-----------Lining material___XP-46----Size: Diameter-,;U_._........... <br /> .- - <br /> - -----Depth---°��-----••------------- <br /> Cesspool: Distance from nearest well________________ Distance from foundation-------------------.Lining material.-----....... <br /> - <br /> ❑ Size: Diameter--------------------------------------Depth---•------•---------- --------------- -----------Li Liquid Capacity <br /> - - q -------•-----------•--------9als. <br /> Privy: Distance from nearest well------------------------------------------- Distance from nearest building <br /> ❑ Distance to nearest ]of line_________ _________________________ <br /> Remodeling and/or repairing (describe):--------------- _ <br /> r � --------------- <br /> 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)------------- <br /> _- 4.4----------- ( - ------------------------ <br /> ------------­----------- <br /> - - - - ontract _ <br /> By:.-•-----------------•-------------------------- �� (Title._. -- <br /> - ' '------------•----- -- -( ) 57ze_ -----..._ <br /> (Piot plan, showing size'of lot, location'of em in relation to wells, buildings, etc., can be placed on reverse side). <br /> t <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- . <br /> ----- -- ------ ------------------- DATE----- /� !- <br /> VIEWED BY -_-_-_- ----•---•----------------------- -------------- --------------- ----- DATE-----------------•• --------------------------- <br /> BUILDING <br /> , <br /> � P�ERM..ITs_ . <br /> I:S <br /> SUED - -------- <br /> Alterations and/ore ------------------- DATE-------•---•------------------------------------------------- <br /> me <br /> ­ , ------ <br /> -- --------------- <br /> __V <br /> ---- <br /> FINAL INSPECTION BY:.. .,c----- - Date-----�- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Sweet 124 Sycamore Street <br /> 205 West 9th StrsoT <br /> Stockton,California Lodi,California Manteca,California <br /> Tracy,California <br /> ES 9 REVISED 8-59 2M 5-52 ATLAS <br />