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rvn: urritrt ubt: <br />---- - -------- <br /> ---%�­-------------------- --------- <br /> ---- APPLICATION FOR SANITATION PERMIT Permit No. ..1/ ��._. <br /> (Complete in Duplicate) <br /> " This Permit Expires 1 Year From Date Issued Date Issued -- �.` } <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and ins°fl thf w- - oe <br /> This application is made in compliance with County Ordinance No. 549. i''- "-""" descdescribed. <br /> JOB ADDRESS AND CATION_ ,___ Aa <br /> --- ... .- <br /> -4.................----------------------- <br /> Owner's Name— <br /> ------------ <br /> - <br /> -----•--•----------•• <br /> -------------- Phone.. -------------••---.... <br /> Address--- ._. ._ <br /> --- --------- ----•-------------------•-•----------------------•--•---------....................... <br /> Contractor's Name............ . . ... <br /> -----------•---.-...-.--r-------Phone <br /> ­ <br /> Installation will serve: Residence Apartment House ❑ Commercial <br /> ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: j---- Number of bedrooms _-,1_ Number f baths --I--- Lot size ----------------------- <br /> ..........................-------•--- <br /> Water Supply: Public system E] Community system [] Private Depth To Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan [ ` <br /> Previous Application Made: (If yes,date------------------ _) No ❑ New Construction: Yes ❑ 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 /> ------------- <br /> El No. of compartments Sixe - Liquid depth--------------------------Capacity P tY <br /> Disposal Field: Distance from nearest well--------------- -Distance from foundation------------.-------Distance to nearest lot line____--..._-__. <br /> ❑ Number of lines---------------------- ------Length of each line-------------------- -�-_:Width of french--------.•--_-_•-- <br /> --------•-----•- <br /> YPe of filter material.:rte.=-//------'-------Depth of filter material---------------- ----Total length-----.----------_-_-----•----------- <br /> Seeps Pit: Distance to nearest well-----L-_�--o_.__Distance from foundation--.1-c-.,.__._Distance to nearest lot line.- � <br /> Number of pits----------I---- ----- <br /> - Lining material__.�,�+�-Size; Diameter----__.�� _ <br /> -•- ---------.Depth---- ''�--------------- - <br /> Cesspool: Distance from nearest well------------- Distance from foundation--------------------Lining material-.--- <br /> ------------------------- <br /> ---..-------___---_._--_-._ <br /> ------ <br /> Size: Diameter.----- ---------- -----------------Depth-----------------•-----• --------- --------------.Liquid Capacity <br /> --------------------------- <br /> gals. <br /> Privy: ' Distance from nearest well---_-----_---- _--- .-..--__-------Distance from nearest building <br /> Distance to nearest lot line_____________________________ <br /> .Remodeling and/or repairing (describe):----_..-. _ ,e,e <br /> ----- ---- <br /> ------------------ <br /> ------------------•------.---- <br /> ------------­---------- ••--------------••----------- <br /> ------------•----•------•-----•--------------------------...-------------------------••-------------•---------••--•-•------•--------------------•----- <br /> 1 hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State S. and rules and egulations f the San Joaquin Local Health District. <br /> (Signed) ------- ----------- e <br /> ------ <br /> ---------------------------------------------------- "&ffdM Contractor] <br /> t <br /> By----------------•-- <br /> --------------------- (Title)--------------------- <br /> {Plot plan, showing size of lot, location of system : relation to wells, b ildings, efc., can be placed on reverse side). i <br /> FOR DEPARTMENT USE ONLY f <br /> .. E <br /> APPLICATION ACCEPTED BY- _.- . _ DATE..REVIEW `ro <br /> EDBY---------------------------------•---------- ----------------•---------------------- <br /> ------ -------------------•-----•- - DATE-----------..---------•-•---------•---•-•---•- - <br /> BUILDING PERMIT ISSUED------------------------------------- <br /> Alterations and/or recommendations:--"-._.--._.-..- <br /> --------------------- <br /> ------- -•--••-------- ---------"--•-----•--- -------•---------•- <br /> FINAL INSPECTION BY:.. ___ ------ Date--�---_ +/c...� / <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street <br /> 405 Wert 91h Street <br /> Stockton,California Lodi,California Manteca,California <br /> Tracy,California <br /> E5 9 REVISED 8-59 2M 5-62 ATLAS <br />