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A _ICATION FOR SANITATION PER f Permit No. _441.2 <br /> (Complete in Duplicate) /e-/—/ <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 install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> � r <br /> JOB ADDRESS AND.,LOCATION.._._ _ <br /> ------- --------------- <br /> y / <br /> Owner's Name 4—7, ------------- Phone------------------------------------ <br /> Address ---------------------------•--•------- ---- ------------------------------------------ <br /> -------------- -------------------------------------------------------- ------•-------------- <br /> Contractor's Name--------- .............•--•-----•---------------------------------• -- Phone..--•••-•--•------------••--------- <br /> Installation will serve: Residence partment House Commercial E] Trailer Court [-] Motel El Other El <br /> Number of living units= Number of bedrooms ._ Number of baths Lot size !� 1 ------------ <br /> Water Supply: Public system ❑ Community system ❑ Private jx_Depth to Water Table �4� ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay X Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date_.__ . .. __) No�e New Construction: Yes No ❑ FHA/VA: Yes ❑ No0 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> 1 <br /> S-ptic Tank: Distance from nearest well]_0._s__ Distance from found0ion__- --------.MZ t ial�____. __..___.._.._... <br /> No. of compartments. '_._..._____._.__Size_ .X.�_Q__X_ ._-_Liquid depth_....... .......�_.Capacity...9 <!2_..___ <br /> Disposal Field: Distance from nearest well.-7�------Distance from foundation `.._......Distance to nearest lot line................. <br /> Number of lines___....,_{ ._ __.._ ._Length of each line------- Q _.....Width of trench-----'.�....�_��.............. <br /> Type of filter material._,�7._-1�j�k Depth of filter material___- _._....Total length----- -_+�..____.. <br /> Seepage Pit: Distance to nearest well___................_Distance from foundation------------.-------Distance to nearest lot line............... <br /> ❑ Number of pits-----_----------------Lining material--------- ___._ <br /> -- --Size: Diameter--------- - --------Depth--------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation---.................Lining material..................................... <br /> ❑ Size: Diameter-------------------------------------Depth------------------------ ---------------------------Liquid Capacity............................gals. <br /> Privy: Distance from nearest well--------------_------------------------------____Distance from nearest building____---------_-------------__-_.-.__...._. <br /> ❑ Distance to nearest lot line--------------------_------ ----- ------------------------------------•-------------•----------------•----------- - <br /> w � <br /> Remodel' d/or epairin describe):---- <br /> -- - ---- -- ----------- ------ ------------------ <br /> ----------- <br /> --•--•------------ - - - ---•------------------------------------------------------------------------------------------------------------------------ -•--------•------------ -•---- .mac <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 Local Health District. <br /> \ v , ,n <br /> Si ned 1 -- ------ ---- ------------ --- ---------- ------------------ --- Owner and/or Contractor <br /> Title ---- -- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY---- -------------------------------- ---•---- --- ---- -- ------­----------------------- DATE------------------------------------------------------------ <br /> REVIEWEDBY---------------------------------------------------------- _ ------------ - DATE------------ <br /> _11110-01111! 4- <br /> � 3 y <br /> BUILDING PERMIT ISSUED.......... ---•-•-------•-•-----•- - -1i'"= DATE <br /> Alterations and/or recommendations:--------------------------------------------------•---------------------------------------------------•-- <br /> --------------------------------------------------------------I............................................................................................................ <br /> ----------------------------•---•-----•-•----------•-------•-•....--•-••••...---------------•------•------------••----•--••---•-----•-----•---•------------•----•---.. ... <br /> -----------------I-----------------------------------------------------------------------------------------..................................................-•--......... <br /> ...............................--------•---................................. ------•-----•------•---------------------------•-------------•--••••-•---•-•---•-...--••---•-•---_...... <br /> ............................................ ......................................... --------•----- -----...--••-----•---•----------••----•.._...----•---- --- <br /> FINAL INSPECTION BY:----,�{ �?.._4- --------- ------ - Date-- -------/_/-___L._-4_.,2- <br /> �-------_---------- ------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Stro*t 124 Sycamore Street 205 West 9th Street <br /> Stockton, California Lodi, California Manteca,California Tracy,California <br /> E6 9 REVISED B-59 2M 5-61 ATLAS <br />