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rUKUrl-K-L USE: <br /> --------- -------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .___.__.•_----._, <br /> ------ ------------------------------- ----------------- (Complete in Duplicate) Date issued __ --` ,3 <br /> ----------- This Permit Expires 1 Year From Date Issued r/ .� /- <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein chscribed. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS A OCATIO -, _ ^, n --- --- <br /> _ � <br /> Owner's Name . --------- Phone------------------------------------ <br /> Address <br /> ------------------------- --- --- <br /> - ---------------- -- - <br /> Address l~ -V- -- '.. -----• -------------------- <br /> o r <br /> Contractor's Name ----- ---- --- --- -------------------------- ---------------- Phone_---------------------- <br /> - <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other * <br /> Number of living units: J__- Number of bedrooms _:'`Number of baths -----f-- Lot size --------- <br /> --•--------------- <br /> Water Supply: Public system ❑ 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 ❑ 1 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer <br /> wer is available within 200 feet.) <br /> Septicc.Tank: Distance from nearest well----rs__-----Distances from foundation.....��------.Matei i ff_____. -«-t►(�.- <br /> [f] No. of compartments----------3''......--Size.. ,fC._1��i�`_ r_-__.Liquid depth--------- -------------Capacity--- t3- t <br /> Dispos i' Field: Distance from nearest well...............Distance from foundation-------------------Distance to nearest lot li5e------...---___._. <br /> Number of lines----------------------- ------Length of each line---------/.0,0...........Width of french------- <br /> Type of filter materiaLAr-R-_a_------Depth of filter material--------/_K.°f----Total length-------- ,0-D----------------------- <br /> Seepage Pit: Distance to nearest well----- ----------------Distance from foundation--------------------Distance to nearest lot line----------------- 6 <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth-------------------------------- 01 <br /> Cesspool: Distance from nearest we}I______._-..-- Distance from foundation--------------------Lining material__________________________________ 40 <br /> ____ <br /> ❑ Siie: Diameter--------------------------- ----------Depth----••-------- -------------------------------------Liquid Capacity----------------- - gals. S <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.-----.__--___---_---____----_._--._-----. <br /> ❑ Distance to nearest lot line--------------------- ----------•------- <br /> Remodeling and/or repairing (describe)-------=----------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------•-----------------------------•------------------------------•---------------------------------------------------------------------------------------- <br /> ----------------------——------------­­­­------........-------------------------------------------------------------------------------------------------------------------------•------------------ --------------- <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, Sfate ws, and rules and'regula ' ns of the S n Joaquin Local Health District, <br /> c <br /> i <br /> (Signed) -- ---- ................................. <br /> ------------- ----------------- weer and/or Contractor <br /> � . <br /> Ely. - -' --r '� ='{Tytle)-= .`n-------- ` -- ._ <br /> (Plot plan, showing size of lot, location of system in relatio ott wells, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - ---- ------------------------------------------------ DATE--- 3 <br /> REVIEWEDBY--------------------------------------------- -------------------- -------------------------------- ------------------------ DATE------------------------- <br /> ---------- <br /> ---------------- <br /> BUILDING PERMIT ISSUED-------•-----------------------------------------------------—-------------------------------------. DATE <br /> Alterations and/or recommendations:_---- -------------------------------------------------------------- <br /> -•-----------------------------•----------------------------------------------------- -------------------------------------------------------------------- .---•---------------------------------------•--------•---------- <br /> ------------- --------------------- ---------------- - -------------------- -----------------------------------,---------------.------------------------------ ----------------- ------------------------------------- <br /> FINAL INSPECTION BY:../-- ��G ---- -------------- Date__�J: --.�` <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Na:elton 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 B-59 31A 3-'63 F.P.CC. <br /> F <br />