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y L APPLICATION FOR SANITATION PERMIT Permit No. .� - __ ..� - <br /> r o lets in Duplicate) 9/ter <br /> Com G <br /> P Date Issued <br /> This Permit Expires I 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 described. <br /> This application is made in compliance with County Ordinance No. 549. �J�J <br /> JOB ADDRESS AND L ATION___.li -------- <br /> -----tmltap�-----I'-'-`�` ---------------------------------------------------------------------------------••- a <br /> Owner's Name-------_V4 --------------- <br /> Phone-----------------------•----------- <br /> -Y - <br /> Address----------•- --�--- �1------------- - � --- <br /> Contractor's Name--------------------- ----- <br /> sv----------- ------------------------•----•-------------- ----------------- Phone------------ -------------------- <br /> Installation will serve: Residence ❑ Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __.____ Number-of bedrooms tljd.___ Number of baths ___ ,__ Lot size _11a4I' --- _ <br /> ----__--..__ ------------------ <br /> � <br /> Water,Supply: Public system G4�Community system ❑ Private ❑ Depth to Water Table ft. �� I <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam ElClay 11Adobe®/Hardpan ❑ I <br /> Previous Application Made: Yes ❑ No New Construction- Yes ❑ No Uj-"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.) <br /> Septjc fT;ank: Distance from nearest well------------- Distance from foundation--------------------Material---------------------------------------------- <br /> ... <br /> `%X /IrJ,4 No. of compartments--------------------------Size--------------------------------Liquid deP.th---------- ---- ---------Capacity----------------------- <br /> D�posal Fie : Distance from nearest well________________Distance from foundation--------------------Distance to nearest lot line----------------- <br /> � ]ST!tl� Number of lines----------------------------------Length of each line------------------------------Width of trench- _.-- - ----,--------------------- <br /> Type of filter material____________ ___________Depth of filter material____-___----.___-_.Total length__-_____.____---_:--____-----_ -_-_-_.--_- <br /> Seepage P' Distance to nearest well____^r-r"_____Distance from fo dation____f ---------Distance to nearest lot line___±•------ q,•� <br /> Number of pits_-_-/-___._____-Lining material__ =.Size: Diameter.---- Q_____.---_Depth-_. y1..._�_____.___-_ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-----__-------------Lining material l.-_----_-__--.-------.-.-.-------_. <br /> Size: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well---.--'__---------------------------------------Distance from nearest building------.----------------------------------- <br /> ---------------------------------------------------------- <br /> ❑ Distance to nearest lot line ---------------- = <br /> Remodeling and/or repairing (describe)---------------------- - - - �'- fJ ..___..___ <br /> rr�_ <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, S+ate laws, and rules and regulations of the San Joaquin Local Health District.? <br /> (Signed ——----_ (Q•wner or Contractor) <br /> -.. - <br /> By:-----------------------•-•--------------------- ------ ---• -( - ------------------- (Ti+le) J f' l-' <br /> (Plot plan, showing size of lot, location of Sys", to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----------T-7�R-1-0-r-------------------------------------------------------------- DATE------- -_rC�------ - <br /> REVIEWED BY------------------------ --------------------- -------------------- --------------------------------.... DATE------------------------------------- <br /> ---------------------- <br /> BUILDING PERMIT ISSUED------------- ------- DATE-------------------------------------------------------- <br /> ---------------- <br /> and/or re erfdations._-__ ____- _.__...___.__ ._ _ <br /> --- - -- -- - - --------------- <br /> O <br /> -- --------------- <br /> ------------------------------- --- ------ - <br /> ---------------------•------------ <br /> ----------------------------- ----- .... ...................R <br /> FINAL INSPECTION—B Date.-.---- ------------- ......... - ------ ------ ---------- <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 4 t .Lodi, California x Manteca, California Tracy, California <br /> ES-9-2M Revised 8-'59 F.P.Co, <br />