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_.�.�--�•:5�/ <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued ----�,J <br /> 1-�4_1 <br /> This Permit Expires 1 Year From 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 compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND OCATION -------------------------- --- ------- --- --------- "? .. -----------------•-- <br /> /7` '! ---- -- <br /> ------- Phone------------------------------------ <br /> Owner's Name----- --- ----- - - �-------------------•-----•----- <br /> -" ��"�°�.- _.. --------------• ---------------------------------------------- <br /> Contractor's <br /> --------------------- <br /> Address--------------�•-��---" ---------------------- <br /> Contractor's Name---� Phone----------------------------------- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial 9 Trailer Court ❑ Motel ❑ Other ❑ I <br /> C<-Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size "------t--------------------------------------------------- <br /> 4 Water Supply: Public system T Community system ❑ Private ❑ Depth to Water Table-""""".- ft. <br /> Character of soil to a depth of 3 feet: Sand;n Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> { <br /> Previous Application Made: Yes ❑ No New Construction: Yes T 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_47" -----Distance, fro foundation---fib--.........Material---e4 ------------- <br /> No of compartments...n2c Size.. Y'" " 1 T--------Liquid depth--.----Z/-------------- Capacity..l <br /> Disposal Field: Distance from nearest well�_O_t__-_Distance from foundation..."�"Q_ "---"".Distance to nearest lot line"" - --""--- <br /> Number of lines--------"l- "-_"""""------ Length of each line-----/-01-0----------------Width of french----�-q" /------------------- <br /> Type of filter materia" -Depth of filter material-_-- ---"--------Total length"Imo_"""------------------------- <br /> Seepage Pit: Distance to nearest well__----"-___.--------Distance from foundation--------------------Distance to nearest lot line--._"""--- -"".". <br /> ❑ Number of.pits----------------------Lining material---------------------- Size: Diameter-----------------------Depth--------------------------------- <br /> Cesspool: Distance from nearest well----------__----Distance from foundation--------------------Lining material -.----------_--------_----------- <br /> ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> ..-----Distance from nearest buildin C <br /> Privy: Distance from nearest well""-_--_-.""-__.""._ � """""-""""""" -----� <br /> ❑ Distance to nearest lot line------------------------ ------------------------------------------------------- <br /> Remodeling and/or repairing (descr;be)=--------------------- ---------------------------------------------------------•--------- ------------------------------------------------------------- <br /> _ <br /> --_----------------- --- ---- ---------- --- <br /> -- -- --------------- -------------------------------------------------•------- - - - --- <br /> ---- ------------------------------- -------- ----------- <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 /> —(SiTgned)----- - - ---- -------- -------------- --------------------------------------------(Owner and/or--C <br /> ontr--a-c--t-o- <br /> r) 1"• <br /> ---------------- <br /> By:------- -- -------=---------- ------------- --(T�tl --- <br /> (Plot <br /> 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 /> ' r - -- DATE"".e"_"14_741---- --------------------------- <br /> APPLICATION ACCEPTED BY = ------------------------------------------------- " <br /> --------------------------------------- -- DATE------------------------------------------------------------ <br /> BUILDING <br /> BY---------------------------------------•-----�------ ------------------- - - - <br /> - -----------------------------•-- DATE----------------------------------------------------------- <br /> BUILDINGPERMIT 155UED-------------------------- -------------------------- --------- - -- <br /> Alterations and/or recommendations:---------------------------------------------- --------------- <br /> ---------------------------------------------------------------------------------------------- <br /> - ----------------------------- <br /> FINAL INSPECTION BY ---- - -- ----------- Date--.,,/,.-- ---- -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT ' <br /> Sycamore Street 814 North "C"#Street <br /> 130 South American Street 300 West Oak Street 132 S Y <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M Revised 0-'59 F.P.Co. <br />