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F R OFFICE USE: <br /> ay - - f <br /> ---- - ------ <br /> APPLICATION FOR SANITATION PERMIT Permit No. __...____•_._ .. <br /> - -------------------------------- ----------:--------- (Complete in Duplicate) <br /> - � pate Issued ..-.. ._�..�_.... <br /> ------------- _------ This Permit Expires 1 Year From 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 /> f is made in compliance with County Ordinance No. 549. <br /> This application <br /> 1 `�I n 0 tZ!3 r <br /> JOS ADDRES 1 D LOCATION ------- <br /> �J� �Q <br /> Phone..... 42-�- <br /> Owner's Name-- - !/ <br /> Z <br /> Address---------Z----- 2 <br /> Contractor's Name ---------------•-`---------------------------------------------------------------------- Phone. <br /> Installation will serve: Residence �rtment House ❑ Commercial ❑ Trailer Court [I Motel �of1CNumber of living units: _.. .. Number of bedrooms ._ - Number of baths Lot size _.. .--.---...----------.. .... ._-------------.--_ <br /> Wafer Supply: Public system ❑ =-Community system ❑ Private�pth to Water Table 'bft. <br /> Character of soil to a depth-of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ <br /> Previous Application Made: (If yes,date-----------,---------) No [ New Construction: Yes �d❑ FHA/VA: Yes 0 No [A� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public Sewer is available within 200 feet.) <br /> Septic Ta Distance from nearest w <br /> -- Distant from f ndation_-TD.___...__.Material---- .- <br /> �gg,, ,g -0,r i <br /> No. of compartments... .. . . -Size__` .._ 'C_. �/.....Liquid depth_.. -.--.. Capacttyf. ....--. r <br /> Disposal Field: Distance from nearest well -----..Distance from foundation,-=�e----.._-...Distance to nearest lot IineJ.._.... <br /> r <br /> Number of lines._:�..�..____............._...Length of each line..�L�---------------------Width of trench..____ . ..�-..___-__.--......... <br /> Type of filter materia/ G .---------Depth of filter material--1 '- ----------Total length__..Ir4.:------._---__---.-:.. <br /> i <br /> See ge • - Distance to nearest well---- 4.t`.----------Distance i[om foundation--./__d..___..-..Distance to nearest lot line_—----------- <br /> Number of pits----c2 -----------Lining materialQ_.G-4-t­-t.---Size: Diameter-_,: �?-- --------Dept h------ ----------- <br /> Cesspool: Distance from nearest well...--------------Distance from foundation--------------------Lining material..................-.._- ---------- <br /> ❑ Size: Diameter----------------------}--------------De th-------------------------------- ----Liquid Capacity gals. C <br /> Privy: Distance from nearest well-------------------------------------------------Disfance from nearer'+'building_.------------------------------------ <br /> o. <br /> _.........- .-__-------__-_.-- <br /> ❑, Distance to nearest lot line------------------ ---- --------------------- ------------------------- ------------------------------------------------------- <br /> Remodeling and/or repairing [describe)------------------------- ------------------------------- -----------------•---------------------------------••------------ --------------- ----------- <br /> --------------- <br /> - [� <br /> -----------•-------------------------------------------------------------------------------------------------- <br /> -----------------------------------------------I----------------------------------•--------.-----------------------------------•---------------•-•--------- <br /> I ------------------------------------ ------------------`------------------•-------- -----------------.-----------------------------------------------------------------------------------•------------------------------------ <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 re tions o he San Joaquin Local Health District. <br /> Signed( ) ------------------------------- (Owner and/or Contractor) <br /> ---------.-•-------• <br /> By-------------•------ ---- - ---- --------------------------------------------------------(Title)------------------------------ ------------ -------------------- <br /> (Plat plan, showing size.o cati system in elation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY `� -- -- �- -------------------- DATE <br /> �------------------------------------------ - <br /> REVIEWEDBY-------------------------------------------- ---- ------- --------------------------------------------- DATE= <br /> BUILDINGPERMIT 1SSUED----`-•------------------------------------=--------- - --------------- s----- DATE------------------------------------------------------------ <br /> Al#erations and/or recommendations: =f - �' ----- �-- ��-----fi-t-� - ------------ <br /> - <br /> •-------------•------- ---------------------------------------- --------•-----------------------------------•--- <br /> y <br /> -------------------------_._... <br /> ----- <br /> ---------------------------------....-----.---------------.-----------------------------'--------------------------------------'---------I------------------------ ------------------ <br /> I FINAL INSPECTION BY:------- -j'-------- <br /> 'z". gate 1 �1__% <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1401 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 9-59 31A 3-'63 F.P.EO. <br />