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FOR OFFICE USE: <br /> ------------------------------------- ------------ <br /> APPLICATION FOR SANITATION PERMIT Permit No. •- - <br /> (Complete in Duplicate) <br /> ----------------------------------------------- Date Issued .__...._�..�_... <br />----------- <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 LOCATION...._ - <br /> Owner s Name. Phone <br /> Address. t `� --- -- ------- <br /> -------•----•------- •----------•• ••-----------------•------•---•--- 4 <br /> Contractor's Name.__ t !�"" ` ��_^ 1E�. <br /> 0. ----- Ph. --_------- <br /> Installation will serve: PResidence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _1____. Number of bedrooms A- Number of baths J.___ Lot size •___ -----------------•---------------- <br /> Water Supply: Public system ❑ Community system ❑ Private ® Depth To Water Table _47-D ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 4 Clay Loam ❑ Clay ❑ Adobe❑ Hardpan <br /> Previous Application Made: llf yes,date------------------_} No E� New Construction: Yes.® No ❑ FHA/VA: Yes ❑ Nn q i <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 <br /> ❑ <br /> foundation--------------------Material.._-____-___._._.._____-•--•_-------______--___ <br /> No. of compartments_______-_________----_--Size------------------------- -=---Liquid depth--------------------------Capacity..------•------ - <br /> O <br /> Disposal Field: Distance from nearest well___,-------Distance from foundation---l9�...........Distance to nearest lot line--------------- <br /> Number of lines..____'------- ----- ---- Length of each line--- .............Width of trench-___I'.�_'__-________-------_- <br /> Type of filter material r__i�9--------Depth of filter <br /> material-------1.9_____-__---Total length-----l�B--.-.-------••-------• <br /> Aeepage Pit: Distance to nearest well-------------------___Distance from foundation-----------.........Distance to nearest lot line------------- 4 <br /> Number of pits-----------•----------Lining material------- - ------------Size: Diameter------------------------D <br /> epth-- M1 <br /> ❑ t <br /> Cesspool: Distance from nearest well____--__.-__-_-_Distance from foundation--------------------Lining material--------------- <br /> l] Size: Diameter-------------------------------------- <br /> _____.__-....__�.i ` <br /> SiDitDepth------------------------------------- --------------Liquid Capacity--- ------------------------gal j E_14 Privy: Distance from nearest welk-------------------------------- ---------- -- Distance from nearest building------------------------••--------------- <br /> �_V? <br /> [� Distance to nearest lot line----- -------------------------------------------------- ---------•------••-------------•------------------ <br /> Remodeling and/or repairing (describe)----- -- ---------- ---------•--- -----•-------•-------------..-----------------•--------- <br /> ••------•-------------------------------------------- <br /> -•- •------•---------------------------------------;------------------------- - <br /> ``'-------- -----••---------•--- <br /> --------- ------------•------•----- -------------••----- <br /> --•--------------------------------- . � <br /> ------- ---­-------------------------------------------- --------------------------------"-••-----------------------------------;-------•---------------•-------------------- <br /> hereby certify that I have prepared this application and,that the work will be done in accordance with San Joaquin Coun <br /> ordinances, State <br /> laws and rules and regulations of the San Joaquin Local Health District. <br /> i <br /> ------------------------------------ (Owner and/or Contract' �� <br /> (Signed). -(----------- -------4-- <br /> ----- - <br /> By:-- - Vale)------------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> i s FOR DEPARTMENT USE ONLY <br /> l e <br /> ` --- DATE.... "G ------- ----------------------- <br /> APPLICATION ACCEPTED BY__ - - y -- ;`, <br /> REVIEWED BY----------------------------------------------•-------------------------- --------_--------------------- <br /> ----------------• DATE-----------------------------------•---------------------- <br /> BUILDING PERMIT ISSUED-------------_----------- --_-. DATE-------------------- <br /> - <br /> Alterations and/or recommendations-------------------------------- __...---•----------------•-------••-----•---------.................... <br /> ft # --------1--------------------------------------------- ---------------------------------- <br /> . <br /> ... <br /> ---- •---•-••--- <br /> FINAL INSPECTION 8Y `� <br /> Date.... -------------- --------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,Californla Lodi,Callfornla Manteca,California Tracy,California <br /> E5 9 REVISED a-59 ZM 5-62 ATLAS <br />