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/ � 0,q-- ---- -- ----- ----------------------------- <br /> F, <br /> -- ----- ----- -- ---- <br /> - �- -- ---- ----------------------_____..__ APPATION FOR SANITATION PEItMI Permit No. .....__... . <br /> x----------- -------------------------------- -- (Complete in Duplicate) / <br /> -------------------------------------------------- --- This Permit Expires 1 Year From Date Issued <br /> Date Issued 6f� � <br /> 1Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> 11"This application is made in compliance with County Ordinance No. 549. <br /> FJOB ADDRESS A OCAT10 -- - --------klkll-------------------- <br /> , <br /> _iOwner's Name------ <br /> -- -- ...... -- <br /> Address--------------- <br /> . - --•- --------------------•- <br /> Contractor's Name .----/k- ------------------- Phone......................... <br /> • ; <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: ___ __ Number of bedrooms __dumber f baths -__/__ Lot size _ -- - <br /> ..,Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table F!'_ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe❑ Hardpan ❑ <br /> I i <br /> P <br /> F <br /> revous Application Made: ilf yes,date_______._-,_-_ ) No E] New Construction: Yes �No [__1FHA/VA: Yes ElNo E-1 TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cdsspool permi+ted if public sewer is available within 200 feet.) <br /> Septic ank: Distance from nearest well------_____Z, Distance;from foundattion-----'4---------.M terial--- _--_-__________ <br /> ---------------- <br /> No. of compartments ?� Size _____ _ <br /> p ----- .� � ._�:_.�__Liquid depth--- --------------------Capacity... <br /> �-�-- <br /> e f � <br /> Dispos veld: Distance from nearest welh� ----Distance from foundation----/4___-------Distance to nearest lot line._.__-____-. <br /> Ft Number of lines------- -------------------------� Len th of each line_.--- L)--(3--�---- ` <br /> - g �---- - f • ----Width of trench----�-•-7----•-------•--•---- .� <br /> Type of filter material -lLqd-A___Depth of filter material----_�-s�-----__---__Total length----- _t..5�---------------_----------- <br /> Fi <br /> Seepage Pit: Distance to clearest well__ __________________Distance from foundation__..._.___________..Distance to nearest lot line__..._______..___ <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter----•------------------Depth--------------------------------- <br /> 'I <br /> Cesspool: Distance from nearest well________________Distance from foundation--------------------Lining material-------------------------- <br /> ❑ Size: Diameter--------------------------------------Depth__..------------•---- ---------------- -----------Liquid Capacity------------------------ <br /> Privy: Distance from nearest well___________-------------------------------------Distance from nearest building <br /> ❑ Distance to nearest lot line <br /> F <br /> Remodeling and/or repairing (describe)=------------------ <br /> -------------------------------_-------------- ----------------------- . <br /> ---­.­­------­--------- <br /> ---------------------------------I-------------------_--------------------I-------------------------- <br /> ------------------- --------------------------------------------------------------------- <br /> -------------------------­-----------------------I-------------------I-------------------------------------------------------------------------------- --------------------- ------------------------------------------ <br /> j l hereby ce y that I have epared this ap -lication and that the work will be done in accordance with San Joaquin County <br /> ordinances, S at I ws, and rules nd re lation f the San Joaquin Local Health District. <br /> _ C�l __�� <br /> (Signed) --- . <br /> - • , ----- <br /> (Signed) }--------------------------------------------------•------------_rid/or Contractor) <br /> t - ----- -- --- <br /> BY:........ - ----------------­-- - - (Title)----•--------------- <br /> (Plot plan, showing size of to+, location of system in relation o wells, buildings, etc., can be placed on reverse side. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_ � r - `� <br /> f'% =.kms= r?.4 - DATE. �' <br /> REVIEWEDBY--------------------------------------------- ------------------------------------------------------------------------------- DATE------- ----•--------------- <br /> BUILDING PERMIT ISSUED DATE <br /> Alterations and/or recommendations:----------------------------- -----------------------------------------•- <br /> -----------------•-----------------------•---•------•----------------• ------------•---------------------------------•----------------------------------------------------------------------•-------------------------------- <br /> E'i <br /> ----------------------------------- <br /> ---------------------------•-----------------------------------------------------•-------------------------------------•----------•---------••-- <br /> „• �f <br /> _" ---------- <br /> FINAL INSPECTION {-:��.�,s�•T�I=_------•-•----- Date----------------- <br /> SAN <br /> ---f--=- --SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> F-111601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> F <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED a-59 3M 3-'63 F,P.CO. <br />