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APPLICATION FOR SANITATION PERMIT Permit No. ------ <br /> (Complete in Duplicate) 1� �5 <br /> Date Issued <br /> Zip -v2m -0/ <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein desc ' d. <br /> This application is made in compliance with County Ordinance No. 549. <br /> 'JOB-ADbRE55 AND LOCATION O __ .. - -- --,-,/G � <br /> `�`' • -••--------------- <br /> Owner's Name------------t� ------- -- - --• ------ `i--- ------------------ ----- ---------- <br /> yph <br /> Phone--------------------------------� <br /> Address-----------(! _. -�"••-- -- ----- ----------- - <br /> - - -- -- -- -- - ---Contractor's Name --------------------- -- - ----- --- - ---------------------------------------. one <br /> Installation will serve: Residencf Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Nurnber of living units: _,f____ Number of bedrooms --k- Number of baths ___�__ Lot size l��-__-�____z_------r__ _ <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table Z;:f <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Adobe Hardpan ❑ <br /> Previous Application Made: Yes ❑ No New Construction: Yes ❑ No [ K 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 /> Se is Tank: Distance from nearest well_ (, _ 'Distan`e fr ~j fou }i ___� _-__.Mat dal J__ ________________ ______. <br /> No. of compartmen ---- _-��l_�_ _•_ r uid depth_------!---�7�-Capacity.__ B _--/- p_, <br /> Dispk)s I Field: Distance from nearest well- 17from foundation------ ----Distance to nearest lot line__3o_.___ <br /> Number of lines-______�____ __________ ` Length of each line_ _1f1_ r__7Q__.Width of trench_____2 �,_<..--____._._ <br /> Type of filter material_S_�, -De th of filter material_- - 9_...........Total length----- <br /> Seepage Pit: Distance to nearest well___:______'- Distance from foundation___________________.Distance to nearest lot line----­---------- - <br /> E! Number of pits---------------------Lining material-----------------------Size: Diameter------------------------Depth------------:-------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation_-------------------Lining material_____-_-___----_-__-_______-_-_______- <br /> ❑ Size: Diameter-------------j-------•--�------------De th----------------------------------------------------Liquid Capacity------------------------•--gals. <br /> Privy: Distance from nearest well--------------------------- _________________Distance from nearest building______.__________________---------------_. <br /> ❑ Distance to nearest lot line------------------------------------------------------------------------------------------ <br /> Remodeling and/or repairing (describe)=-------------------------'-------- ------------------------------------------------'----------------------------------------•---------------------------- <br /> -------------------•----- ------ - ------ - ---------- -----,------------------------------------------------------------------------------------------------------------- ------ <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, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> {Si nedG, <br /> g �------------------------•---•------------------------------------.--------------------------------�---------- --- --- - ------------------------------------{Owner and/or Contractor) �V <br /> By: ------(Title)------------------------------------•-------------------------- <br /> (Plot plan, showing size of lot, location of system in.relafion to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY 1 <br /> APPLICATION ACCEPTED BY-------•-------------------------------- -•-------------------------------- DATE--- <br /> --- <br /> REVIEWEDBY------------------------------------------------------ -- --- ---- - - - - ----------- ---- • ----- ----------- DATE-------- --------------------••-------------,------------ <br /> BUILDING PERMIT ISSUED--------------------------- -----------------------I-------------------------------- DATE----------------------------------------------- <br /> -------------- <br /> Alterationsand/or recommendations---------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------•--------------------------------------------------------------------------• -------- ----•-----------------------------------•----------•-----•--------------•---• f <br /> ------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------••---------------•------------------------ <br /> ---------------------------------------------------------- - ------\ --•------------------------------------------------------------------------------•------•---------------------------------------- <br /> FINAL INSPECTION BY----------- --- --____-- Date...... <br /> ---_ v. <br /> - ----------- -------- <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 1-57 F.P.CD. <br />