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FOR OFFICE USE: <br /> ----------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. _.__ .. <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 install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> ,3 <br /> JOB ADDRESS AND LOCA I N � �---•-- •.. .. <br /> .bOwn ----------------- <br /> Owner's <br /> er's Name---- !'la.... - •... --•--- ------------------------- --- Phone.................................... <br /> Address---•------------__57a.z. --------- <br /> ,p ------------------------------------------ ---------------------------------------------------------------*......... <br /> Contractor's Name--------------- �e ----•------ .•-- .. Phone................................... <br /> Installation will serve: Residence ©Apartment House ❑ Commercial ❑ Trailer"Court ❑ Motel ❑ Other ❑ <br /> I <br /> Number of living units: -_ __ Number of bedrooms .o_�2_ Number of baths _.l__• Lot size J-4.9 Z <br /> Water Supply: Public system Community system ❑ Private [:] Depth To Water Table j�fr t. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam`ey"�Clay Loam ❑ Clay Adobe❑ Hardpan ❑ <br /> Previous Application Mader (if yes,d6t -------------------- No New Construction: Yes❑ No ®-;�—FNA%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 __tQ9------ <br /> Distance from foundation---/ --------Material__-_ !-� <br /> t [�� No. of compartments-----A---------------Size-e� .-Liquid depth____ /---------Capacity___,f;7 <br /> I <br /> Dii <br /> sposal Field: Distance from nearest well.___T-S----.Distance from foundation....f�f-------Distance to nearest Iodine---c2..__...... <br /> Number of lines.'_.---�-��___`>_____----___Length of each line_____ ____.__.....__.Width of trench_._ ..-_____._____-*-__________ <br /> Type of filfer.materiaL_..f,15G!G/ -Depth of filter material.,__Z&Fl�..__Total length_._.... -_�__________________•__ <br /> Seepage Pit: Distance to nearest well____�_______________•_•Distance from foundation............--------Distance to nearest lot line._____________.._ tV <br /> • El ------------_----- <br /> Number of pits-- Lining material-----------------------Size: Diameter-----------------------Depth----------•---------------------- <br /> Cesspool: Distance frommearest well-----------------Distance from foundation._--_.--------------Lining material____.._________________..._________-_ <br /> ❑ Size: Diameter---•----------------------------------Depth---------------------------•------------------------Liquid Capacity---------------------------- <br /> Privy: Distance from nearest well----------------------------------- <br /> ------ <br /> --------Distance from nearest building_--____________________ <br /> ❑ Distance to nearest lot line <br /> Remodeling and/or repairing (describe)------------- ••- T - ----- , -•__- _ �. �.,, <br /> ------------_- ----------•---------------------------------------------- ---------------•-------------...------•---••--------•------------•--•---------•--- <br /> ----- - <br /> sz.. _�rU .� - .� '' ----- 6# 11 Q_ '... � f R:T x.13.------S�_ Vt <br /> i <br /> ------------- ------------- =-----------:=-----------------••-----------------...... -------------------------------- <br /> I <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 S Joaquin Local Health Districfl <br /> -- r �-- <br /> -(Signed)-----------------------------------------------•-- ---------- - ------- •- ----- --- --------------•------------._.- ------------•---------------- r Contractor). <br /> By:-------------------------------------- Title. <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i <br /> ( FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---------7-t ------------------------ ---------------------------------------- DATE-------- - ) ' <br /> REVIEWED BY -------------- DATE <br /> BUILDINGPERMIT ISSUED--------------------------------------­--------------------••--- ----------------------------------- DATE--------------------- <br /> Alterations and/or recommendations:_.------------------------------------------------------- <br /> -----------­-----------•------------------------- ------------------------------------------------....--------------------------•-----------------------------------.------------------------------------------------------------------- <br /> ------- <br /> ------------------------- .......-------------- •----------------------•-----------------------------------------.-----------------•-•-•-- •----------------------------------•---------------------••------------- <br /> --------------­---------------- 7 <br /> ) <br /> FINAL INSPECTI - - - ----- ---- - ----- Date-_---- ------------------------- <br /> SAN <br /> ---- ---SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 2M 5-62 ATLAS ' <br /> l � <br />