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APPLICATION FOR SANITATION PERMIT <br />(Complete in Duplicate] <br />Permit No. <br />1 <br />This Permit Expires I 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 Ord' n ce No. 549. <br />JOB ADDRESS AND LO AT Q (�� LPION----- C} L-"--------------------------- ...............----------'-- <br />Owner's Name --------------- ±j / .4-4-.444 <br />-----------------------------------------------------=•----------------------------------- - Phone- ---•--•--•---------------- <br />Address --------------------------------------- 1_ 6--1-�� <br />Contractor's Name. --- -- ----------------------------------------------------•------------------------ Phone -----•--------•--------------------. <br />Installation will serve: Residence b� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br />Number of living units: '____ Number of bedrooms -`3-_ Number of baths __4-__ Lot size <br />Water Supply: Public system Community system ❑ Private ❑ Depth to WaterTable -------- ft. <br />Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br />Previous Application Made: Yes No ❑ New Construction: Yes;g�,No ❑ FHA/VA: Yes„k No ❑ <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank or cesspool permitted if public sewer is available within 240 feet.) <br />Septic Tank: Distance from nearest welt---- ------------- Distance from foundation--l-0---------Materi L/ --- <br />No. of compartments -------- .�_--_---.-_-- Size ___- _�c.X_,F'_ Liquid depth-_--_----.?`----_-_-_- Capacity_--. -_�QC_ <br />Di a€ Field: Distance from nearest well -_-------_---.Distance from foundation ------ l--t'�_....... Distance to nearest lot lipe;-i--��____ <br />Number of lines ___-__.-____.2------- --------- Length of each line-�.Width of trench._____.___ ____�`__ <br />Type of filter material epth of filter material---------- - ------Total length_----_-_-----_.�j-_------- +�--__ - <br />T" <br />Seepage Pit: Distance to nearest well ---------------------- Distance from foundation --- .--------------- .Distance to nearest lot line __-------_.---_-_ <br />❑ Number of, pits ---------------------- Lining material ----------------------- Size: Diameter ------------------------ Depth --------- .---- ------------------- <br />Cesspool: <br />__._______--____ <br />❑ Size: ce f om nearest well ----------------- Distance from foundation -------------------- Lining material _--_---_----_-.---.---------__-___ <br />p Diameter -------------------------------- ---- Depth -----------------------------------------------------Liquid Capacity ---------------------------- gals. <br />Cess ool: Distance fi <br />Privy: Distance from nearest well_:-- --------------------------------- -------------- Distance from nearest building ------------------------------------------- <br />Distance to nearest to#{line_-;----.. <br />❑ rt. <br />---------------------------------------------------•--------------------------------------------------------------------- ' <br />Remod lin and or repa•�ing (describe)=----------------------------------------------------------•------------------•----•_•------------------- --------�-•------•--------------- - , <br />g d/ <br />or <br />----------- ---------------- - ------ ------------------- /.,5�- -.a <br />- <br />------ ------ -- ----- <br />--:�.::: _ ------------ ---- <br />------------------------------------ - - ---- - ' <br />-- <br />I hereby certif t I prepared. his application that +he work will be done in accordance with San Joaquin County <br />ordinances, St �e la sit r e e an Joaquin Local Health District. <br />(Signed) -1---rld//?_'"ki.--�r------------------------ ----------------------------------- --- --------------------(Owner and/or Contractor) <br />Bg - (Title) )----------------------------------------------------- ----- - <br />(Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY---------------------------- _ ..-- DATE ----------�__-- _-- --•- --- <br />REVIEWEDBY---------------------------------------------------------------------------------------- DATE------------- - ---- - <br />BUILDINGPERMIT ISSUED---------------------------------------•-------------------------------------•--------------------- DATE----- ------------------ ------------------------------- <br />Alterations and/or recommendations:...... --------------------------------------------------------------------------------------- -- - <br />---------------------------- <br />FINAL INSPECTION BY: ------ f'-- ----------------- Date------. <br />jr . <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br />Stockton, California Lodi, California Manteca, California Tracy, California <br />ES -9-2M Revised 6-'59 F.P.Co. <br />