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APPGCATION FOR SANITATION PERK Permit No. ...... ..... <br /> ------------•-------------------------- ------------- (Complete in Duplicate) <br /> Dote Issued __._ll <br /> ----------------------------------------------- --- This Permit Expires 1 Year From Date Issued ` 1..6.v <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 1,0CATION h ------------------------------------ <br /> Owner's Name_.__ �y <br /> Address------ [' <br /> Contractor's Name ------ -- -- - --------- ' -- -- Phone................................... <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __'-__ Number of bedrooms _`"___ Number of baths _./_.. Lot size. ..................... <br /> Water Supply: Public system ❑ Community system ❑ Private ET-*Depth to Water Table _ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe El'-H-ardpan ❑ <br /> Previous Application Made: (If yes,date -- ---------------- No � New Construction: Yes ❑ No ®—FHA/VA: Yes ❑ No W4— <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> S ,ptic ,Tank:, Distance from nearest well----- -----------Distance from foundation-------------------Material---------------_------- ......................... <br /> 5 ri.-I%' No. of compartments------------- -----------Size------------------ --------- Liquid depth----------- - -- -- ---Capacity.......... ............ <br /> Disposal Fiqld: Distance from nearest well.-_,s$71___10_._Distance from foundation---,1}_.'._....._.Distance to nearest lot line-Z-44.7..._.._. <br /> > < Number of lines_____/.-----. en th of each line___ ,rte ' <br /> --�-------------- 9 � -- '------��-----.Width of trench- -��__•.-•�•.--- -----•-•--...-- <br /> f. �y Type of filter mate rlal.fl,�/ �s,CDepth of filter material---,/, _.____._Total length..._/��.......................... <br /> See age Pit:- Distance to nearest well__l_E' _______Distance from fo dation__/�/��__.___.Distance to nearest lot line...� 7 Number of pits---.......... .....Lining material__/�'.e1 ....Size: Diameter__ - p - � �,� <br /> t - Depth <br /> Cessroo Distance from nearest well------ ----------Distance from foundation___ _ ------------- Lining material..................................... k! <br /> Size: Diameter----- -- - ------------------------De th--------------------------- gals. <br /> ❑ P -- ._Liquid Capacity-----------------••-•----•- <br /> Privy: Distance from nearest well---------------------------------- __.. ____-_Distance from nearest building.......................................... <br /> ❑ Distance to nearest lot line-- --------------------- --------------------- <br /> /�/� <br /> Remodeling and/or repairing (describe:-----------------6�'�"�1 '-Fs------ G--�k'-��-s�--?-��- =�-----•--••------...--•--•-------------------•--------•-----------•--•---- <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, anq rules and regulations of the San Joaquin Local Health District. <br /> 1 <br /> (Signed) _ TTTyor Contractor) <br /> By: �>9t� --------- -------(Title)--- <br /> (Plot plan, showing size of lot, location of syste relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------------------- ---------- --------- -- - --------- -----------------_-- ------ DATE---- = = _ <br /> REVIEWEDBY------------------------------------------------ --------------------•---------------------------------------- DATE............................................................ <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE..... ------------••------•--•-----------------------------•- <br /> Alterations and/or recommendations: --=---------f------ .......n----------------- -------------`.......i.: , ...-•...-•-.........---- <br /> ---------------------------------••------•---•-------•--•--------------------------------•--------- ----------•-------------------------------------------•-----------------•-------•--•--------•-----•--------------------- <br /> -•••-••-•---•.... ................•----•-----•--------------•-----•--------•-----.----••--•----•------------- ••--....----•---------------•----------•---••-•---------•---••-•--•----.....---•--------......-•---•-••••----•-- <br /> .--------•---••-•-----------•---- --------- -_ .................. --------------------------- ----------- ------------- ----••---•-.---_._.......--------....-•-•-•---------••-•---------------..._------.........-- <br /> FINAL INSPECTION BY:-- -- -------- - ---- - ---------- Date `•('„....... ._-`--= <br /> SAN JOvAnl1IN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 2M 5-61 ATLAS <br />