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APPLICATION FOR SANITATION PERMIT Permit No. .../.'2:.'/ ;z <br /> (Complefe in Duplieatej Date Issued ._11��I.�P--�• <br /> This Permit Expires 1 Year From Date IssuedVVT o os-- l 1?o--4/ <br /> •Application is hereby made to the San Joaquin Local Health District for a permit to co �ork herein d�scrbed. <br /> This application is made in compliance with County Ordinance No. 549. — <br /> JOB f{DDRFSS AND LOATIbN -...- ev 4;L <br /> ---_-----. .. <br /> Owner's Name-� - -+_ ................................................-'-- <br /> Address <br /> -.......-.. <br /> _.. � --- ---• <br /> Address:.....-_�'f-- ---I <br /> -----_��.---.rD'._�._._..-._�-.... r ---�----..._.-_. E..............�j .-�.... <br /> Contractor's Name......... <br /> - .--...-'---..-...... Phone..- <br /> -- --..-- <br /> Installation will serve: Residence ❑ App me t House ❑ Commercial ❑ Trailer Court <br /> Motel ❑ Other ❑ <br /> Number of living units:. Number of bedrooms ........ Number of baths l'_- Lot size .............5­611114.0,06.491a.-...-..-....... <br /> Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table Awo ft. <br /> Character of soil to a depth of 3 feet: Sand [IGravel [-] Sandy Loam [IClay Loam[IClay Adobe❑ Hardpan ❑ . <br /> Previous Application Made: Yes d nd <br /> No �g New Construction: Yes ❑ No X FHA/VA: Yes ❑ No❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank oe cesspool permitted if public sewer is available within 200 feet.) <br /> Septic,Tank: Distance from nearest well---------------Distance from foundation......._...........Material................................----------.-.-.i <br /> ❑ No. of compartments..........................Size.............-...............--Liquid depth...................-.....capacity----------_--..---_-- <br /> Disposal Field: Distance from nearest well................:Distance from foundation.......-....._.--Distance to nearest lot line................. 1,3 <br /> 41 <br /> ❑ Number of lines...................................Length of each line_....................._.....Width of trench.......-.-.-.,.-................... <br /> Type of filter material-------- -----------Depth of-filter material.....................-Total length.................:._.-------------�.-,..,4 <br /> ff / �+ <br /> Seepage Pit: Distance to nearest well----.-/-d.(�. _D{stanca from fo ndation._..,,�62�.-.Distance�o nearest lot line...-.r7-...-...- <br /> Jb�f 1 De } <br /> Number of pits---.....�-...........Lining matenal-- ----. .. ..Size: Diameter....... .......Depth ----•-----' - \ <br /> •Cesspool: Distance from nearest well.................Distance from foundation..............._...Lining material.............-_--------.---------._._ <br /> 11 - <br /> Size: Diameter`---...-...._..----- --------....Depth..........- -------------------------Liquid Capacity.. _-----_---_------gals. <br /> Privy: Distance from nearest well.-....._.................................-.---Distance from nearest building.-.-----,...--------........-.......... <br /> ❑ Distance to nearest lot line...............-------......-_.....--..- ........--_------..--_- -.-.......-............_...........---.............................. <br /> c <br /> Remodeling a . . el:-_.--••-:� ---- ..t+-._.. .-- •---------'-- -....-..__ <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, and rules and regulations of the San Joaquin Local Health District. <br /> � <br /> (Signed)------ /.�Si4.<d9r�- _�--.. . :_��..+��_4,' -.-.�..a- 1'�a'--`__'-'-{ }°r Contrast <br /> (� or} <br /> BY:•--- -� - t - - ................... ------••---==.-... ITitle}.-----..-.-.....-•-- .-.....-.__............................. <br /> (Plot plan, showing size of lot, location of system in r ation to wells, buildings, eta, can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY i <br /> APPLICATION ACCEPTED BY.- - . ............ .....................................-....................... <br /> .....- <br /> REVIEWEDBY......................................-...---' -----.............__-------•---------------------------------_ __ DATE... _•-----_-----------_.----•----••------ <br /> BUILDING PERMIT ISSUED.....- _..----._.._ -........-�-....-------.....---•...---........ <br /> DATE................... ----------....-------... -_---.-. <br /> Alterations and/or recommendations:---- ---............................................................................----..................._--•--•---------...----..._.....-........ <br /> --------------- .................. .......................... ...-... ................................._...............--.....................................-.........................._.............. <br /> - --.....----................_..---------....-.....-----_....--......--_,-----_.......----_.....................---......•-...................------------.......--.............................. <br /> ............................................ .......----.._.................--...-....:..----.-.-..:.. .:.:-...---•--•-•---'--.-.....-_-.--...---•----—.............................................. <br /> FINAL INSPECTION BY: - 4 , �� Date--/�2_ -4 D -�d----.-....-_.-....---.--.......... <br /> -.-.._. <br /> • SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Skeet 300 Wast Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> E5.9-2M Revised a.'59 F.P.C.. <br />