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)-UKUFVI E USE: ' <br /> ------------------------- ---------------------- -------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. . <br /> -------- - ----------------------------- --------- (Complete in Duplicate) � <br /> -------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued -_____ _l_360 <br /> Application is hereby made to the San Joaquin Local Health District for a permit to con stru Install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATIONls,r _; � <br /> Owner's Name------------ <br /> vJC ---•------ 9� -------------------------•---- ------------------------------------------ Phone-----------------------------....... <br /> Address ! ----- ------ ---- - -----------------------------•--•-•-------------------------------•------------------------------------------ <br /> Contractor's Name.. ------------------------------------------------ ......... --•----_-_--•-- <br /> '►-�-� --••--------------._...---•--------•------------.._...._.... Phone <br /> will serve: Residence,M Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __f_____ Number of bedrooms ,,3____ Number of baths _AX__ Lot size -----------------------________________ <br /> Water Supply: Public system ❑ Community system ❑ Private [U Depth To Water Table " ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay X Adobe ❑ Hardpan jR <br /> Previous Application Made: (if yes,date--------- ----------} Noe] New Construction: Yes.a 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.) Q <br /> Septic Tank: Distance from nearest we;L-S0------Dista fro foundation---/'..........Material______ ------__ __ <br /> ® No. of compartments____.�-.___-____�_____Size7 f_—_tsr_____-Liquid depth-----�----------------Capacity_102-&'T....... <br /> ; <br /> Disposal Field. Distance from nearest well__eQ-_-----Distance from foundation----ZQ.........Distance to nearest lot line__-!;"______ <br /> ® Number of lines___A_____ ________-------------Length of'each line_.-./�4__--__.___-___-.Width of trench___ <br /> Type of filter materia} __�_ .CDepth of'filter material____f_g_y________Total length__, - ........................... <br /> Seepage Pit: Distance to nearest well-/ "---------Distance from foundation.../A.'....__..Distance to nearest lot iine_t-__-_______._ <br /> ® Number of pits.--�--------------Lining material.--------Size: Diameter_._.3.3_4---------Depth_-�- �-•.--- _------- <br /> Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material............................... <br /> ❑ Size: Diameter--------------------------------------Depth----•-----------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well_________________________________________ _______Distance from nearest building----------------------------------------- <br /> F1 Distance to nearest lot line--------------------------------------------------------------------- <br /> Remodelingand/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, State laws,And rules andre ulations o the San Joaquin Local Health District. t <br /> (Signed) ------ -------------. ___. ----- (Owner and/or Contractor) I <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). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-11,44",---, ------------- -----•--------------------------------------- DATE--- .------------------------ <br /> REVIEWEDBY---------------------------------------------------------------------------------------------------------------------------- DATE.---- --------• --------------------------------•---------- <br /> BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE-------------------••--•-•---------------------------------- <br /> Alterations and/or recommendations:-------------- --------------- ------------------------------ -----•--•-----•--•-----•------••-----•----------------•-•----•--------•-•-----••------------- <br /> -•--------------•----•••-----•---•-•--•-------------•----- ------------------ -------•------------------ ------. ---------- ----------------------------------•-----------•--•---•---•---------------------------•------------ <br /> ---------- ---•---•---------------•------------------ ••-- ----------------------------------------•- --- ----------------------------------------•-----•--•--•-•---•--------•----••-•--•---------------•----•--•------------ <br /> FINAL INSPECTION <br /> .�1y SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 134 South American Street i �`1�y 300 West Oak Smoot 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Loch,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 2M 5-62 ATLAS <br />