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APPLICATION FOR SANITATION PERMIT Permit No. ----_h__ <br /> (Complete in Duplicate) i <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 construct and install the work herein described. <br /> This application is made in 0"' 11 nce withithiCounty Ordinance No. 549. <br /> JOB ADDRESS AN LO t L%� i � f' <br /> Owners Name----- -- - --------- - -- �� - -----E'1 - - - -------___--- Paone_�� r <br /> Address------------- f <br /> Phone <br /> J' 4' <br /> Contractor's Name-�tv��--� �_. __ ��_- AP <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court (� Motel ❑ Other ❑ �` I <br /> Number of living unit si 4-. --- Number of bedrooms k___ Number of baths _Ir__- Lot size _-1 b__.t'_3_ +r ._. _ _________ i <br /> Water Supply: Public systemil❑ Community system ❑ Private ❑ Depth to Water Table -------- ft. le <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ .l wdp;sn [E 1 . <br /> Previous Application Made: Yes ❑ No ] New Construction: Yes No E] FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest weli�49___+_ Distance rom foundation10__:_-------Material---- __ _____p__,___________ - <br /> p -------------- __Yt_---%-P--------Liqui p. ------------------Capacity---, _ <br /> No, of com artments._. __ Size__a d depth <br /> p 'I � � b <br /> iom nearest eil_. .^�....Distance from founda i n____d '______.Distance to Heaves of line-4r 7 Disposal Field: Number of lines_____I___________-------------- Length of each line_ .�------------Width of trent - ±�------,------- ._------ <br /> Type of filter materia} u_ Depth of filter materia!___f _"_________dotal length__ __________________ <br /> i <br /> Seepage Pit: Dis#ante to nearest well----------------------Distance from foundation___.______.._______.Distance to nearest lot line_______._____.___ C <br /> ❑ Number o� pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------- ---"p. <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material___----------------------------------- <br /> Siiameter--------------------------------------De th----------------------------------------------------Li Liquid Capacity gals. <br /> 1l <br /> F-1 Size: Dp q p Y <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------ ---._. <br /> ❑ Distance to nearest lot line------ -- ------------------------------------------------------------------------•------------------------------------------------------- -. <br /> Remodeling and/or repairingi(describe): <br /> ---------------------------------------------------I------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------- <br /> M <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, Stafe laws, and rules. and regulations of the San Joaquin Local Health District. <br /> (Signed)-------,_[-- c' -�rvG__ �- - �`--- -- C- J (Owner and/or Contractor) <br /> ----------------------------------------------------------------- <br /> BY--------------------------------• ---------------------=----------------------------------------------------------------------------(Title)---------------------- ------- -- ------------------------------ <br /> (Plot plan, showing size of lot �location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> ..i <br /> APPLICATION ACCEPTED 13Y __________________________ DATE__l47'3___1I <br /> -- --------------------------------- <br /> REVIEWEDBY-------------------------- -----------------------­.......... --------- ------------------------------------------ DATE----------------------..---------------- <br /> BUILDING PERMIT ISSUED---:!1l- --------------------------------------------------------------------------------------------- DATE---------- -------------------------------------------------- <br /> Alterations and/or recommendations------- ---- --------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------- -------------------------------------------------------------------------------•----------------------------------------------------------------------- <br /> .IM <br /> ------------------------------------------------------•-•--------•-------------------------------------------------------- --------------------------------------------------------------------------------------------- <br /> -----•------------------------- -------- --------A---------------------------------------------------------------------------------------------------------------------------------------I-----------------•------- <br /> ------------------------ ------ ----------- ------------ -------------------- --- ------=:-- ----------------------------------------------------------------------------- <br /> - -- <br /> FINAL INSPECTION BY:_ _ Date_,!- _ A7-- --------- <br /> SAN JOAQUIN LOCAs. HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M Revised 8-'54 F.P.Co. ,l <br />