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FUR OFFICE USE: -_— <br /> r <br />_________________________________________________________ <br />-------------------------------____..__.__.___---_.-_-- APPLICATION FOR SANITATION PERMIT Permit No. ...;1 -�` <br />---------------- --------------------------------------- (Complete in Duplicate) 1f <br /> ----------------------- --------- --- This Permit Expires 1 Year From Date Issuer! Date Issued ......_...�.1 _6 -t._-- <br /> �!2 <br /> Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. <br /> This application is made in complian a wit County Ordinance No. 549, <br /> JOB ADDRESS AND CATION. _:: _ <br /> Se <br /> ------ <br /> Y , • <br /> Owner's Nam ---------------- ----- -------- Phone................................. <br /> -i <br /> Address .... 40--- <br /> ------------------ ---- <br /> Contractor's Name-------------------------------- ........ Phone............... ................. <br /> Installation will serve: Residence Apart t House ❑ Commercial ❑ Trailer Court ❑ Mo el ❑ Other [] <br /> Number of Giving units: . ..___ Number of bedrooms __ Number of baths __7�Lot.size ___�_.�_ ,.� ----------- <br /> Water <br /> ---_----Water Supply: Public system ❑ Community system [] Private Depth To Water Table 57_ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ -Clay ❑ Adobe Vf Hardpan ❑ <br /> Previous Application Made: (If'yes,date.---_I___---------__) No X- New Construction: Yes 1K <br /> No ❑ FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available w:tlli X00 feet. <br /> Se is Tank: Distance from nearest well-) �Q �_ r✓ <br /> istanc from oun ateon_____ Mate Lal <br /> No. of compartments__.-... ---- q P <br /> S;ze_-- 7/---Capacity_../-3_6-�_- <br /> Disposal Field: Distance from nearest well_ - __ .._.. ce from foundation___._ ._4)_____-Distance to nearest lot line.- .... <br /> �'_ _ Length of each <br /> Number of €ines_, ___--!__---._. Len line__ _- 04•"-�- <br /> 9 -•-•,1-- _ -�'dth of trench----2:-�------------------ <br /> Type of filter material._S _ dlepth of filter material--.1_6`_r__-__._..Total length-_.gt-4.©----------------------- <br /> Seepage Pit: Distance to nearest well---------------------- from foundation....................Distance to nearest lot line-.-_-___-______._ j <br /> F1Number of pits----------------------Lining material-----------------------Size: Diameter-------------_---------,Depth----------._-------•_ <br /> ------------ <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-________________________________________ Ni <br /> -------------- <br /> ❑ Distance to nearest lot line.___._______ :: <br /> Remodeling and/orjairin d ------------------------------------ <br /> scpbe : - --- ___-- d!� <br /> �. <br /> --- --------•------•--------------------------------------- <br /> ---------------------�' _ <br /> ---------�}r--.)L—- ------ a -� � <br /> - -•-•-- ------------- �. <br /> - - ----------- <br /> -----------------------------•----------------- ------------------------------ - '� ` <br /> - --— --• -------------------------••---------------.-...----------------------- - <br /> hereby certify that I have prepared this application and that f e work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and reg laftons of the San Joaquin Local Health District. <br /> (Signed)) .._- --•-•----- - ----------- - (Owner and/or Contractor) <br /> By: -------------------------------------- ----------------------------••-------(rifle)------------------------------------------------------- <br /> - (Plot plan, showing_size_of lot, location of systemjn,relation to wells,.buildings, etc.,.can be placed-on reverse side).--,, ......... <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------ -------------- ------------- ----------- ------- -------- --------- ---------- DATE.... --- --�. <br /> REVIEWED BY ------------------------- ----------- DATE------ . <br /> --•--- ----•----------------------- � <br /> - ------------- - <br /> BUILDING PERMIT ISSUED-.--••----------------------••----------------- DATE <br /> --- --- <br /> Alterations and/or recommendations------------------------------------------------------ A <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----•--•------------------- ---------------------- -•---------------• ---------- ----------------••---------...----------•----------------•--------------..------------••----- <br /> ---------- -•----------------•--------------------- •--------•-----------------•--- ----------------------•-------------•-----------••--------------------------------------------------­ <br /> ----------------- ..........--•----- --------------- <br /> FINAL INSPECTION BY-------- ------ ------------l -- -- <br /> - -- ----------------------- Date------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Strut <br /> Stockton,California Lodi,California Mantua,California Tracy,California <br /> ES 9 REVISED a-59 2M 5-62 ATLAS '�-„•--- <br />