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FOR OFFICE JlSfi: <br /> ----------Z--------------------- APPLICATION FOR SANITATION PERMIT Permit No. .. - <br /> ---------- ------ ------------------- -------- (Complete in Duplicate) <br /> Date Issued <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 described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION------3.912-3-------- -=------ -fitsL-----------------------------------------............------------------------------------------ <br /> Owner's Name L Phone.�i�G?4!.�'Y-1T_.. <br /> Address.......-...... -------------------------------------------------------------------------------------------------------------------------------------------------------I------------- <br /> Contractor's <br /> •-----•---------------------------- ---•....-------------•------------- <br /> Contractor's Name......... JA-�..... :SAN}---------j-A1C -------------•-------- ------ Phone..lf <br /> Installation will serve: Residence Q' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: .../__- Number of bedrooms _3____ Number of baths ..1-____ Lot size ................... <br /> Water Supply: Public system ❑ Community system ❑ Private a Depth To Water Table _11. _ ft. (� - <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [Clay [Adobe EEr Hardpan ❑ VV <br /> Previous Application Made: (If yes,date-----------_-------_) No Z► New Construction: Yes ❑ No [Er' FHA/VA: Yes ❑ No [►'� <br />' TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 felt.) <br /> Septic Tank:1,rf l Distance from nearest well-----------------Distance from foundation-------------------Material----------------------------------.-------------- <br /> ❑ rim" No. of compartments------------------•------Size----------------•---------------Liquid depfli_---------- --- ----------Capacity-------------------•--- <br /> Disposal Field: Distance from nearest well---- _�_._Distance from foundation•____.lP_!......Distance to nearest lot line----1.4..'_._.. <br /> [ Number of lines---------------1------------------Length of each line..-._-_--A00--'--______.Width of trench-------------�.i�------------- <br /> Type of filter material.._: v4°-lC-.__-_Depth of filter material--------,/e........Total length-----------------------ZO-02.... <br /> Seepage Pit: Distance to nearest well----- .'---_Distance from foundation__•_?V__"...,Distance to nearest lot line__._`f_.�.1.._ <br /> ® ajA Number of pits--------/-----------Lining material__-°h� �`-��-.Size: Diameter-------�•J- ---.Dept h----------2R! ..`...._ . <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- <br /> ❑ Size: Diameter------------ -------------------------Depth------------------------------ ---------------------Liquid Capacity----------------------------gals, <br /> Privy: Distance from nearest well----------------------------------------------- from nearest building_____._____________-___-_-___----____._. <br /> ❑ Distance to nearest lot line------------------------------------------------------------------------................... ----------------------------••-------,------------- <br /> Remodeling and/or repairing (describe):__.._.19epz>_------7z........ �al,4rl>_'t=____ .E' 7 =1xJ_Y..--- ..t'� <br /> T - - ------- <br /> -------------------------------------------------------------- <br /> reby certify that I have prepared-+his 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 Local Health District. <br /> n <br /> (Signed)---------- 0---:___!_=-� -a. ------ ---- -----------------------------------------------------(O ner and/or Contractor)gY: 'v --- -- -- -------------------------------------•---------------------(Title).. - <br /> (Plot plan, showing size of lot, location of system in relation +o wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--`-------- ------------------------------------------------- DATE----- p G- -------------------- <br /> REVIEWEDBY---------------------------------e•- ------- -------------------------------------------------------------------------------- DATE--------------------------------------------------- <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE.............................. •---------------- <br /> Alteratio s and/or recommendations:----------------------------------------------------••----------................----------------------------------- <br /> --G 3 .::._-._ � ��-----..--•---.. -fit--- - ----- -?' = .�.....rr.���c- rr ....... <br /> ------------------------------------------------------------------------------------------------------------------------•-I-------------------- -•-------------------.---------------------------------------------------- <br /> ----------•----------------------------:-- ----- ---------------------------------------------•-----------•-- ------------------------------------------­_----------------------------- ------------ --------------------- <br /> FINAL INSPECTION BY:----- /l_-t- !'`` ' Date....-------,`���3�3----------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 405 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 2M 5-62 ATLAS <br />