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m. <br /> F R O FICE USE: <br /> - - --- - - - <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> = -------- --- (Complete in Duplicate) Date. Issued .: :-` - t-- f <br /> ;. <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 Ordina e N '549 <br /> 5 <br /> AN ATI <br /> ------- <br /> JOB ADDRESS --- <br /> --------- Phone------ --------------------------- - <br /> Owner'sNe._./ ---- - -------- ------------- ----------------------------------- -------------------------- ; <br /> -----1&-------­----------- <br /> Address ` � <br /> Contractor's - <br /> - j <br /> Name = -----------. Phone Oth ------- <br /> ------•---•------•-----rte--------- ---- <br /> Installation will'serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mote ❑ <br /> Numberof living units: .___-- Number of bedrooms _Number of baths Lot size ____ ___ __ <br /> Water Supply; Public system Community system ❑ Private ❑ Depth to Water Table Clay J <br /> i, Adobe ardpan li <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ ❑ <br /> New Construction: Yes No ElFHA/VA: Yes ❑ #No [�- -- <br /> Previous Application Made: (If yes,date-_-------________-) No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> k' r <br /> N j <br /> Septic T k: Distance from nearest well-?!0 ---'Distance from founda ---- _________ _ I <br /> No. of compartments ---------------Size__-- ___--�-a---_ ---T---Liquid depth: CaPacttY,. �a <br /> iA r <br /> Disposal Field.. Distance from nearest well ""'Distance from foundation ]-rye. Width of trench ----------------- <br /> -,Distance to nearest lot lines. '"-""" <br /> �Cf <br /> Number of lines___-__-_"�_._�------------Length of each line---- 4-----��-�- <br /> Type of filter material D_4-- ____Depth of filter material_-1 YC--------------Total length_______ �"'_ ------ J <br /> ____Distanc om foundation__ �' r Distance to nearest lot line_--`'_�-�.- <br /> Seepage it:! Distance to near st well ___--____ ' ' O <br /> Number of pits-' --------------Lining materia{ -v <br /> j_ C--.Size: Diameter--- -----------Depth_-._--.,�-3"' S <br /> i <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_..________-_________--______ ____ <br /> ❑ --------- Depth-------------------------------- Liquid CapacitY---------------------------gals' <br /> Size: Diameter_____--":_______________ <br /> Privy: Distance from nearest well_________________._____--_--_______-----------Distance .from nearest building__________.__________________.__.._____.. <br /> ❑ ----------------------------------------------------- <br /> Distance to nearest of ine----------------------------- ------------ -- - <br /> Remodeling and/or repairing (describe)---- - -------- -- ---------------------•-----•-•-------•------------•-------- -- <br /> ----------------------------------------------------------------- <br /> t -------------------------------------- ----------- <br /> w ---------------•-___---- -__-_-____- -------.... <br /> - - -------------------- <br /> 1 I hereby certify that I have prepared t is applic ion and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and reg ions a he San oaquin Local Health District. <br /> (Signed) - - - ------------------ --------- --- ----- --------------------------------------------------------------- <br /> (Owner and/or Con+ractorl <br /> ------(Title)---------- ---------------------------- ---- -- ----- - ------- <br /> (Plot plan, showing size of Idt;locatio system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> � � - ` f c <br /> APPLICATION ACCEPTED BY------t`"" , ----------- `�``�— ------------------- DATE -� ---- ---- ----------------------- -- <br /> REVIEWED BY----------------------------------------- ----------- --------------------------- --- ------------------- <br /> -------- DATE------ ----------------------------------------------------- <br /> DATE_ _ <br /> BUILDING PERMIT ISSUED -- ----------- - ------ ��C �: <br /> _/ G �-- <br /> Alterations '------- ---- <br /> ----- <br /> and/or recommendations:._____ ______ ___________l'.----"_----- <br /> ----------- ----------•-•--------------•---------------- ---------------- <br /> ---- <br /> ..-.-------- -----••--------- ------F ---------------------------------------- <br /> ---- ------ ------- ----------- ------------------------ <br /> ---------------- ---- --------------------------------- <br /> FINAL INSPECTION BY:_.__...--_- <br /> --------------------------------------- Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,talifornia <br /> Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 9-54 3M 3-'63 F.P.CO. <br /> , x'ti <br />