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APPLICATION FOR SANITATION PERMIT Permit No...i�I._ <br />(Complete in Duplicate) 1! !o <br />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 />,yy' <br />JOB ADDRESS AND LOCATION <br />--------------------------------- <br />----------------------------`-- <br />Owners Name_-, � : - ------ Phone. <br />Address-............ ----------------------------------•---------------------------------- ------------------------­-- ----- <br />//_ //.. <br />Contractor's --Name -------------- 1f_'�` - $--' . Phonez/g=f1��_7.._ <br />Installation will serve: Residence Q --Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br />Number of living units: _ __ Number of bedrooms _- __. Number of, baths -v _ Lot size ... J%_•--� -Q. r-------------------- <br />Water Supply: Public system ❑ +Community system ❑ Private Ertepth to Water Table V.IP ft. <br />Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 23 -"Hardpan ❑ <br />Previous Application Made: Yes ❑ No [�New Construction: Yes ❑ No [P,' FHA/VA: Yes ❑ No El r � <br />TYPE OF INSTALLATION AND SPEGIFiCATIONS: <br />(No septic tank or' cesspool permitted if public sewer is available within 200 feet.) <br />f <br />p ' aAk: Distance :from nearest well .__-..-..'_...... Distance from foundation.............:......Material .... -......... ................................... <br />No. of compartments --••-- --- -:= Size.............. ------­---- Liquid depth .......................... Capacity-- ................ <br />Df posaI F' Id: Distance from nearest well. �.d-0_�,._=.Distance from foundation. /!:...._.Distance to nearest lot lin __-_ <br />./..-__.- <br />Number of lines ---------- 1 ------- _____ _ Length of each line ------ 3.__................_Width of trench__.. {ice_------._.-_-__-_._. <br />Type of filter material_- _5_I__!r�Depth of filter material ------- IT -_-.--.Total length__.._1J---------------•------.. <br />See a e ' : Distance to -nearest well --- /0 ------ _-_Distance fun dation__..%.....::..Distance to nearest lot line.. 3.u`-_...._. <br />p 5 Number of pits�__.___.Lining material.--( Size: Diameter --- 3'_��_... _ Depth ___.a_SS__.�---------------- <br />Cesspool: Distance from tnearest well ----------------- Distance from foundation .._-________._-.___.Lining material ------------------------------------- <br />ElSize: Diameter.-----•-•----••-..-._.--I...._....-.-Depth---- •---------=-----------------------Liquid Capacity .......................... :..gals, <br />Privy: Distance'•from nearest well ___________________________________.-------- ..Distance from nearest building__-_-..-..-_-_._-___-__-----___.....:.__. <br />❑ Distance to nearest lot line ------------------ ------------------- °------- -- ------------------------------------ ----------------------------­---- ----------- ------ <br />Remodelingand/or repairing (describe):---- ----------- -----------------------•----------------=----------•-------•---------------I-------- ---••----•----•---••--------------------------- <br />•••---•--------••............ -••-•---------------------------------------- ................................. _._._..__-------•-- .................... ------------------------------•----•------------: ---- -.. <br />---•----_.---•---------------------•-----...................... .-...... -..------------------------------------------------------------ -,_------------------------• --: ------------ ---- ---- <br />---------•--------------•--------------=----------------------------...._._.__...-•------------•-•--------------------------------------------- --------- •----- ---- --...---....-------- <br />1 hereby that I have prepared this application and that the work will be done in accordance with San Joaquin County <br />ordinances, tate la s, and rules and regulations of the San Joaquin Local Health District. <br />!L S; r {Owner and/or Contractor <br />--------------------------------•----•---------------•----------- <br />(Signed)----------- - -r / ... _...p —' <br />By: -------------- <br />P47 ------ / /"`'j �'/-------------------------------------------------------------- {Ti+lel 5 - -----------•-----------... --------- <br />(Plot 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 p <br />APPLICATION ACCEPTED BY----.-' T4Fst -- ---------------- •-------------------------•------------------•-- - DATE -------1 �� � ". 5.�------.-•.--_-.------------- <br />REVIEWEDBY ................ ___ ... _------------ ----------------­--------- ------------------------------------- DATE----- --------------------------- .................. __L <br />BUILDINGPERMIT ISSUED ----------------------------------------- -------- -----•_-------------------------------- •-.... DATE--------------------- --------------------------------------- <br />Alterationsand/or recommendations:..--.......................................... -------------------------- ---------------------- --.......... -------------------------- •------- •-----------•- <br />------------------------••---..__.._....._......_-.......................... ...._-... •--------------- ------------------------------- --------------------------------------------- _.... -_........ _............... <br />---------------- ------------------------------------------- ............. ---------------------------- .------------------------- -----........... ................ ..._..--------------------------------------- <br />-------------- <br />FINAL INSPECT N BY:..-- ........ - - Date ------ <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />130 South Amaricon Street 300 West CA Street 132 Sycamore Street $14 North "C" Street <br />Stockton, California Lodi, California Manteca, California Tracy, California <br />ES --9-2M . Revised 1.57 F,P.CO. <br />G <br />C <br />4 <br />f, <br />