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FOR OFFICE USE: <br /> - -- - -- ------- 7 .0 <br /> APPLICATION FOR SANITATION PERMIT Permit No- --- ---- ----- �-- <br /> (Complete in Duplicate) / 9 <br />---------- -- Date Issued _------�--�--1-•� / <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 descr e;/ <br /> This application is made in compliance with County Ordinance No. 549. � <br /> k -----' -­------------- ----------- <br /> JOB ADDRESS AND LOCATION ' <br /> Owner's Name--fir ------------------ Phone-----.3- 3------- -- <br /> 1 ---- - ---- ' —r ` <br /> Address ... - ��'! .... -- -• . ms's-/�� ' /c <br /> Contractor's Name_ .. �1_ _. 1E ----------------------------------------------- Phone__15,C9::�� <br /> Installation will serve: Residence Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -_- Number of bedrooms -_/ - Number of baths --1._ Lot size ----- —----------------------- <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -------- ft. F <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam lay Loam ❑ Clay ❑ .Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date-------.--- _) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> •` E t <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: Y <br /> (No septic tank--or cesspool permitted if public sewer is available within 200 feet.) – - <br /> -_�_---Distance from fours ation_ --r._ Material_-__ ----------------- <br /> Septic Tanker Distance from nearest wei ! / _� d� <br /> No. of compartments--�---------------Size .? _- Liquid depth-- ---- ------Capacity--j'-- -- -- --- r <br /> Disposaf Fi Distance from nearest weii.��. ___Distance from foundation-1_Q_�---Mance to nearest lot line--- <br /> ----d---- <br /> Number of lines- __-©-.-� Length of each line--/ 1�-� --Width of trench_--_ _ _fir--.-.------- <br /> Type of filter material- Lc�4 I_--Depth of filter material-------/�`�-_-_Total length-----.1_�-Q_________ <br /> I1line----------------- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation......-------------.Distance to nearest lot <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth-----,---- ----------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------- .---..-___-.-------------_ Z <br /> ❑ Size: Diameter-------------------------- -----------Depth--------------------------- -------------Liquid Capacity------------------ ---------gals. Al <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 /> ---------------------------- ------------ --- <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 and regulations of the San Joaquin L cal Health District. <br /> (Signed)- ---- --- - -- -- /T/ +' --------------------- Contractor] <br /> JL `--------------(T e)-- ---- ---- ----- -- -- - -- --------------- <br /> By: <br /> ttl <br /> (Plot plan, showing size of lot, location of system in rel n to wells, buil gs, etc., can be placed on reverse side]. <br /> FOR DEPARTMENT USE ONLY. <br /> APPLICATION ACCEPTED BY-- - — -- -- - DATE--V/" __� - -- <br /> REVIEWEDBY----- -=-----. •------------- --•-------------------- DATE---•------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED---------------- ------------------ ----------------------------------------------------------------- DATE---------------------------------------- -------------------- <br /> Alterations and/or recommendations:---------- ----------------- --------------------------------------------------------------------------------------•----------- <br /> .----------•----------------------------------------------------------------- ------------------------------------------------- <br /> ---------- ------------ ---------- ----------------------------------------------------------------- <br /> ----- ------------------ --------------<-.- ----- - <br /> F1NAL INSPECTION BY:._,A - : - -------- - <br /> -------- Date- 6._' G` L------------------------------------- --------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> i 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> Es 9 REVISED 6-59 3M 3•'63 F.P.Cs. <br /> R i t <br />