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FOR OFFICE USE: <br /> -.6 4e LIA� <br /> ---- ------ <br />--- ---------I------------:-------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> ....... ---------t.jt <br /> (Complete in Duplicate) Date Issued 7 � <br /> ----------------------------------------------A 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 described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> --------------------------------------------------------- <br /> JOB ADDRESS AND LOCATION.--- ---------­- --------------- <br /> ----------------- <br /> Owner's Name----------- e� Phone., <br /> - e - ---------- ,�--------- <br /> ---------­------�;�--------------- -------- ....... ..... .. <br /> Address-------------- .......... ----------------- ------­----------- <br /> .-•-----------------------------•--•-•-------........................................ <br /> Contractor's Name--•-•--•---•............. -A/.............. e------------------------------- Phone................................... <br /> Installation will serve; Residence Z Apartment House ❑ Commercial E] Trailer Court [I Motel [] Other 0 <br /> Number of living units: --Z--Number of bedrooms Ndmber of baths _'? Lot size _---------- ---------- <br /> k <br /> Water Supply: Public system D Community system [3 Private t jo Depth To Water Tabled ft. <br /> Character of soil to a depth of 3 feet: Sand (:] Gravel 0 Sandy Loam 0 Clay Loam a Clay [] Adobe 0 Hardpan C1 <br /> Previous Application Made: (If yes,date____________________) No [a N-ew Construction: Yes 0 No & FHA/VA: Yes E] No 91 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted'if,public sewer is available within 200 feet.) <br /> Septic Tank- j Distance from nearest well___ Distance from founds)ion--------- 21�_.Material.........Z�-------....................... <br /> dept11-'•.�--------�____'Capacity---------------------5!. <br /> I o. of compartments___________?.._- <br /> Fi <br /> Field: <br /> istance from nearest well.-.-- tion--.-3 Distance to nearest lot line-----;7,�o----- <br /> Disposa Field: e Distance from founda �_ .�)*dth of trench.--------...-:K-�----------- <br /> Number of lines--------------!'�-------------------L�nth of each <br /> Type of filter material._._. of filter material___-.j -------Total length"-__-______ /A�_p________________ <br /> ---------------- <br /> i <br /> Seepage Pit; -Distance to nearest well----./--�2? from foundation_...__.-t Distance to nearest lot line.... <br /> ------------- <br /> 7- <br /> ____.Size: Diameter___, ---------Depth____._-. <br /> Number of pits----- —--------Lining mate <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- <br /> 0 Size: Diameter--------------------------------------Depth-------------------!---------------------------------Liquid Capacity.---------------------------gal . <br /> Privy: Distance from nearest well__________________________-I------------- F.-Distance from nearest building----______.____"____-_________-----------. <br /> ❑ Distance <br /> uilding------------------------------------------ <br /> Distanceto nearest lot line---------------------------------------------- -------------------...... ------••----------------•----------------------------------- <br /> Remodel inq-and/or repairing (describe):_,;,-,.,Z4 <br /> X---- ---- ----- <br /> oe <br /> ........... ------- -71,�_ <br /> �0i, =---_...----- <br /> a;' <br /> he IP..,fy 'that I have pr red this appi. ?. and that the wo'rk will be done in accord nce with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health,Distriset. e_ <br /> t, nee and/or Contractor) <br /> ---------I-------------------------------------(Own <br /> (Signed)--­-------gY� - - -------------- <br /> .. -----------li-------- ------------------------- ------- ---------------------- <br /> ----- ---------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings. etc�Lcan-be placed o; reverse side). <br /> JOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-'-------- ----------------------------------------------------- DATE----- ------ ----------- <br /> REVIEWEDBY-------------------------------------- --------,------------------------------------­-------------------- DATE----------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------- ---------------------•---------'--------- DATE--------------------------•--------------------------­-- <br /> Alterajions pd/or recommendations:------------------------- -------®------------ ------------------------------/­A----------------------------------------------------------------------- <br /> ­ --------------------- ----------- --—-------- - --/---—--------- <br /> xt-i-------- <br /> 5 ef-------- ------------ -------------- <br /> /1.1_1_-- ------------------ ------------------ <br /> ------ ....... -----P-4111. <br /> e-of <br /> FINALINSPECTION BY---------------------------- ---------------------------------- Date----_------------------------------------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 194 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED B-59 ZM 5-62 ATLAS <br />