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APPLICATION -FOR' SANITATION PERMIT Permit No. .( .? <br /> lComplefe 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 insFall the work herein described. <br /> Th's application is made in compliance with County Ordinance No. 549. <br /> ' -. " ._�-.-., <br /> JOB ADDRESS AND' L@ATION_______r _ rr <br /> ------- <br /> Owner's Name----------- <br /> -------------- Phone <br /> IAddress------------------•---------- 41�--•------------------------------------------------------------------------------------------------ <br /> Contractor's Name----------------- <br /> -------------------------------------------------------------------------•-------- -------------------------------------------- Phone..------... <br /> Installation will serve: Residence ❑ Apartment House Commercial W G ,&ed/ <br /> ❑ ❑ Trailer Court ❑ otel ❑ Other+ T/ <br /> Number of living units: -------- Number of bedrooms -------- Number of baths -------- .Lot size ____ _ <br /> --->-------•----------- <br /> Water Supply: Public system Q Community system ❑ Private IX Depth to Water Table ff. <br /> Character of soil to a depth of 3 feet: I Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeL-K-L Hardpan ❑ <br /> Previous Application Made: Yes p No)!'J, New Construction: Yes ❑ No [- FHA/VA: Yes ❑ No' �. <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public ewer is available within 200 feet.) <br /> Sepfiigc Tank: Distance from nearest welL4�------Distan e fr M f ndation---- <br /> No. of compartments-_4Z------------- -Size_ ----_ Liquid dep}h--- ------------._.Capacity_-_,� ------_ <br /> r�~/ T� f <br /> DispoIal Field: Distance from nearest well--- .....Distance from foundati _, -"______.Distance to nearest lot line.__--_---- <br /> 1� Number of lines * __..�, -_--.-----_ Length of each line___? Width of trench. <br />` <br /> Type of filter material_r� _----_ �� <br /> ------------------------- <br /> YP Depth of filter materia! __ -___-------Total length-__--- ?- . <br /> r f <br /> Seepage Pit: Distance to nearest..well----------------------Distance from rfoundation----_------------Distance to nearest lot line----- ---------- <br /> ❑ Number of pits. ----.---. Liming material-----------------------Size: Diameter----------------------Depth... <br /> ------------------------------ <br /> esspool: Distance fromnearest well_"__'_ .-Distance from foundation_-------------------Lining material------__________,_--_--_ <br /> ❑ Size: Diameter----------------- ----------------Depth------------- ----- <br /> r ------------------------------Liquid Capacity------------i-------------=-gals. <br /> Privy: Distance from nearest well-_..___---____-._ tee_ <br /> -------------------------------Distance from nearest building--------------------------•- <br /> Distance to nearest lot line ------ <br /> ._ r- <br /> Remodeling and/or re firing {describe):--------�-------, ------ .�.�✓� ' ;-_Y_ <br /> --- -------------- ----------------------•-------------- <br /> ---------------------------- <br /> --------- <br /> --- -- ---- <br /> -= -------- - --- - - - ---- <br /> I hereby certify that f have epared.this application and that f e ork will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and r ulationsof the San Joaquin ocal Health District. <br /> (Signed)-- - -=------------ ------- ,-- -�--a �------� <br /> -----------------------------------(Owner and/or ContractorBy:-------------------------•------------- _ ifle-- - - ------ ----- ------------- <br /> ) ,;{ <br /> T <br /> ot plan, showing size of lot, location of system in relation to wells, buildings, etc., can :be placed on reverse side). <br /> _ I <br /> FOR DEPARTMENT USE ONLY 1 <br /> APPLICATION ACCEPTED BY---------- --- ------ --- --- -----------/------- - DATE <br /> REVIEWED BY <br /> BUILDING - DATE---- --PERMIT ISSUED ----- <br /> ----- <br /> I <br /> ----------------------------- <br /> ------------ ---- --- ----- ---------- --------- DATE----- <br /> Alterations and/or recommendations_ ----- ------------------`-- <br /> ----------- --- <br /> ------------------------------ <br /> / ' ---- <br /> '�r�---- -------=- . - ��----- --..4------------- ---------------------------- <br /> ------------ _. ' <br /> -------------- -------------- -------- <br /> - <br /> FINAL INSPECTION BY:___ _ __._ Date__....-_ -: <br /> .Odle <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 8-'59 F.P_Co. <br /> � xb <br />