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r <br /> APPLICATION FOR SANITATION PERMIT Permit No. ..l. <br /> (Complete in Duplicate) <br /> This Permit Expires 1 Year From Date Issued Date Issued .._ !!-��f. _0 <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and ir: all the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION---I.l. °�►.S'� �_.5161�1i1C-�__._. _ .#n rii <br /> Owner's Name--------- �-I ... ------------------------------------------------- ----------------------------- ------ Phone.............`-•---------------- <br /> Address-----------_--------S.AC S.Ame----------------------------------------------------------------------------------------------------------------------------- <br /> Contractor's Name--I%,& Phone_lT ��- � <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -------- Number of bedrooms -------- Number of baths -----.-- Lot size _________ __ _________•._-___-___-______.____.__-__-____-_ <br /> Water Supply: Public system ❑ Community system K Private ❑ Depth to Water Table ., ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clayx Adobe ❑ Hardpan❑ <br /> Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ 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 well-----------------Distance from foundation--------------------Material------.__.-.-___________--______-_______________- <br /> ❑ No. of compartments-------------- ------Size----__._------------------ ---Liquid depth--------------------------Capacity........rl�y <br /> f / l `, <br /> Disposal Field: Distance from nearest well. ___Distance from foundati n.._ " ..____.Distance to nearest lot line----------_ .1. <br /> f Number of lines______.__._ ________ ____-..__Length of each line_; t_���� ___.Width of trenchgd��_�__ <br /> Type of filter material. _-_____Depth of filter materia l_r .Total length,l��___ _-_..SF� , <br /> Seepage Pit: Distance to nearest well_-__.________Distance from foundation-'__________________Distance to nearest lot line______.___._-.. <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter______________________Depth-------------------------------._ W <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---.------------------------__._____-. <br /> ❑ Size: Diameter---------------------- ---------------Depth--------------------••------------------------------Liquid Capacity------------------ -------gals. <br /> Privy: Distance from nearest well ___:________._-_.__-_________.___--------Distance from nearest building <br /> -- �/__________________-__-_-_.______- � <br /> ❑ Distance to nearest lot lin ` _ _ ____-------- "'---- �' G <br /> Remodeling and/or repairing (describe):-------- --------------------- -.---. _----- -------------------- <br /> -- ----- • ------ _1� --------------- <br /> ---------------------------- - - <br /> ----------------------------------- ----- -------- ------------------------- -------------------------------------------------------------------------------------------------------------------- --- <br /> 1 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, aules and regulations of the San Joaquin Local Health District. <br /> E � Contractor <br /> (Signed)----------------- ��----pt ) <br /> SEPTIC TA�lY� E,'rr c <br /> BY�-------------------- - -- -- - -------- - - - - -- --------------------(Title)----- --- ------------_ -----___ _ - <br /> A <br /> (Plot plan, showing'size of to ,'to ation o system in rel i n to wells, build gs, etc., can be placed on reverse side). <br /> FO EPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------------------------------------- DATE.._-------------- - <br /> REVIEWED BY ---------------- DATE--- <br /> BUILDING PERMIT ISSUED-----------------------------------------------------/� -- --------------- DATE. -------- ------------ ------ ----- ------------------- <br /> Alterations and/or recommendations:------------------------------------- ----------------------------------------------------------------------------------------------------------------- <br /> ------------------- --------------- --------------------------------- ------------------------ ----------------------------------------------------------------- ------------------••-------------------------------- <br /> ------------------------I-------------------------------------------- <br /> -------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------•--•-------- ----------­-------------------- <br /> ---------------------------------­­--------- <br /> ------------------------------------------------------------------- ---------- --------------------------------------------------------------------- -----------------------------------------------------------------•------------ <br /> - - <br /> FINAL INSPECTION BY------- -------------------------- --------------- ------ -: Date----------- ----- 1 ;�- -�- -------- -------- <br /> SAN JOAQUIN LOCAL 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-'59 F.P.Co. <br />