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... <br /> --------------------------------------------------------- <br /> ------------------------------------ APPLICATION FOR SANITATION PERMIT �ermif No. _- 7 6 6)_.C) <br /> ------------------ -------------------------------------- (Complete in Duplicate) r <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 construe al the wrUher decThis application is made in compliance with County Ordinance No. 549. /9 <br /> JOB ADDRESS AND LOCATION...,_:--._4'��r.�-- _ ��/t/ ` <br /> --------------------- <br /> Owner's Name--------4! -`_ --' -----•--�..1�,�tr� ��------•---•-----•• -- ----•--- Phone----•----------- <br /> -- ---------- <br /> 1 .c. <br /> Address ---- ------- "-- ----1). --�, / < <br /> 10, <br /> Contractor's Name ----------------------- Phone----------•------ <br /> Installation will serve: Residence ® Apartment House E] Commercial F] Trailer Court El Motel ❑ Other ❑ <br /> Number of living units: 1------ Number of bedrooms __1---- Number of baths __i!____ Lot size _________________________ <br /> Water Supply: Public system 21 Community system ❑ Private ❑ Depth to Water Table __------ ft. <br /> Character of soil to a depth of 3 feet: Sand [I Gravel ❑ Sandy Loam [0 Clay Loam ❑ Clay [❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No f�3 New Construction: Yes IR No ❑ FHA/VA: Yes J[Ej No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> e ti D€stance from nearest well_________________Distance from.foundation--------------------Material...._-------------.----------_______-- <br /> No. of compartments--------------------------Size----•--------.t ?---------._Liquid depth--------------------------Capacity------------------------ <br /> Dispgsal Field: Distance from nearest well_4-!_t--___.Distance from' foundation___f_D---------.Distance to nearest lot line_.,._________ <br /> Number of lines-------/------r-------------------Length of each ----------------Width of french---0L-` 00 <br /> Type of filter maferia 9 ISS <br /> Yp - -- __Depth of filter material__-- ---- Total len th__G__Q. ___________-_------- ------ 0 <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation----__--------------Distance to nearest lot line----------.------ 0 <br /> El <br /> Number of pits----------------------Lining material--------------- -----Size: Diameter-----------_--._------Depth--------------.------ <br /> - <br /> lZ1 <br /> Cesspool: Distance from nearest well-----------------Distance from foundation...._.--------------Lining material-- ------------------------- <br /> 171 Size: <br /> .-..--_---_._ - <br /> Size: Diameter----- ------ -------------------Depth---------------------------------------------- ----Liquid Capacity----------------------------gals. Q <br /> Privy: Distance from nearest well----------------_------------------_----------___Distance from nearest building--------______-----____ <br /> ❑ Distance to nearest lot line- ---------------------------- --------- <br /> Remodeling and/or repairing (describe):----- ...�r-f7 �a------ ,t'rv------ --------- <br /> --- ----- --- - -- <br /> fl�" :- .�c't,^_ad . -------------------------------------- <br /> ---------------------------------------------------------------- <br /> ----------------------------------------••------------------------------------- - <br /> - - --------------------------------------------- <br /> I hereby certify that I have p pared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules nd regulations of the San Joaquin Local Health District. <br /> (Si ned <br /> 9 )--- ----------------------------- - ------------- ------------ --------------- -• ----- ---- <br /> -----------------------------------------------------------------Owner and/or Contractors <br /> By:----------------------•---------------------- -- ------- -- ------------------------------------------------------------------(Title)------------------------------------ ------.....------------ .. <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED <br /> - - - --------------- <br /> REVIEWEDBY------------------------------------- ------- ------------------------------------- ------------------------------------------ DATE--------------------------- <br /> BUILDING --- <br /> PERMIT ISSUED-------------------------------------- ---------------------- --------------- ------------------ DATE-------------------- - <br /> Alterations and/or recommendations--- --------------------- <br /> --------------------•-------------------- -------------------------•--------------------------------------------------•------- -------•----•-----------------------•---------- <br /> ------------------------- - ------------------------------->-------------------------- ----------------------------- ---------------------------------------- <br /> ------------------------------­1----------- ------------------------- ------------------------------ ------------------------------------------------------------------- ------- <br /> FINAL INSPECTION BY:...< it'. Date----- r'� <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxellon Ave. 300 West Oak Street 120 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,Cafifornfa <br /> ES 9 REVISED 8-59 3M 3-'63 F.P.CD. �.a� <br />