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FOR OFFICE USE: ' <br /> APPLICATION FOR SANITATION PERMIT- Permit No. ._.f ° _. <br /> - ------------------------------------- ------------- (Complete in Duplicate) s <br /> ____________________ _____ This Permit Expires 1 Year From Date Issued Date Issued'_ _.__.�.6 <br /> '. IO S4,-0q0—O.S <br /> Application is hereby Imade to the San Joaquin Local Health District for a permit to construct and install the w'tsrk herein describe4. <br /> This application,.is_made_in compliance with County Ordinance No, 549. <br /> JOB ADDRESS AN LOCATIL2..............-zP- ]i^! <br /> w d ----------- ----- <br /> . . <br /> a- <br /> Owner's Na Phone------------------------------------ <br /> Address �..3F � • r - ---------------•------• -=------•------------ <br /> Contractor's Name------- --- --- --- ------------------------------------------------------------------------------------ Phone------..------------------------•- <br /> Installation will serve: Residence Apartment House ❑ Commercial .❑ Trailer Court ❑ Motel ❑ Other 'F] <br /> Number of living units: __f---- Number of bedrooms _�:_ _ NumV�e� <br /> baths _._._ Lot size ____________________________ ___________________________ <br /> WatWSupply: Public-.system E] Community system El Privateth o Water Table -------- ft. s <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Applicafion:Made: (If yes,date----- --------__----) No ❑ New Construction: Yes ❑ No ❑ PHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION,AND SPECIFICATIONS: <br /> „r (No septic tank or cesspool }permitted if public sewer is available within 200 feet.) <br /> Septic Tank: . Distance from, nearest well______.._._______Distance from foundation--------------------Material-------------------------------------- ___.-___. <br /> ❑ No. of compactents--- ------*.-Size----- ------- ---- -----------Liquid depth----=---- --- _------ Capacity---------------------- <br /> Disposal Field: Distance from nearest well-- --------Distance from foundation--------------------Distance to nearest lot line----------------- N <br /> �. r.. <br /> ❑ Number of lines-1_________________________________Length of each line---------------.-------____--.Width of trench-------------:--------------------- <br /> Type r <br /> t ., <br /> w <br /> of filter material__._.____``______________Depth of filter material___.________________.:Total length________._______________________________-_ : <br /> 'Seepa Pit: Distance to nearest well-----ILPQ_-�__Distance fir �jfoundation-----/ ./---.Distance to nearest lot line____-�{_------- <br /> Number of pits- -- ---._...__Lining material2l/i --------Size: Diameter------- 3`�__..Depth----- .?�------------ <br /> ' 'Cesspool: Distance from nearest well______________ __Distance from foundation--------------------Lining material------.-------------------_----__--_. <br /> ameter_______________ <br /> ❑ Size!; Di_ _ - --- ---------------Depth-.-------- _-- -- - - ----------------Liquid CapacitY----------------------------gals. <br /> Priv K Distance from nearest well......... __Distance from nearest building <br /> ❑Y I -----" --- ---------------------------------- ---- ---------------------------- ----- <br /> Distance to nearest lot line---------------------------------------------------------------- , <br /> Remodeling and/or repairing (describe):------- la ' <br /> --------------------------------=----------------------- -------------=--------------------------------------- ----------------------------------------------------------------------- <br /> l <br /> = =----------•--------------------------------------------------------------------------------------•--------------..----••---------------------------- <br /> I 3 I hereby cert' that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Stat I `ws, and rules and regulati s o the San Joaquin Local Health District. <br /> (Signed)---------- #........... <br /> ---- - -----x' --- - ----------------------=-------- ------------------------- - Vor Contractor) o <br /> By:..., ----=---- ---- .. <br /> ------ ----- (Title) _ <br /> (Piot plan,showing Size of lot, location of system in ation to wells, buildings,-etc., can be placed on reverse side). <br /> F R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY___ _ ______ DATE....]------_____._. ~� <br /> REVIEWEDBY---- ---------------------------------------- ---------------------- -------------------------------------------------------- DATE-------- --------------------------------------------------- <br /> BUILDING PERMIT ISSUED-------------------------------------------------------------------------------------- --------------- DATE---------------------------------------------- ------------- <br /> Alterations and/or recommendations:------------------------------------- ------------------------------------------- T-----------------•----------------- ------ <br /> ------ ------------------------------------•--•-----------=-----------------------------------------------------------------------------------.--=--------.---•---------------•---------------------------=---------- <br /> -------------------------------------------------------•---------------------------------------------------------- ---------------------------------------- ---------------------------------------------------------------- <br /> -------------- ------- -- ------ ---------------------------- ----- <br /> FINAL INSPECTION,'BY:.... = _ Date--f___'D------1--- ------------------------ ----------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.ka:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 3M 3-•63 F.F.CU. I <br /> -" I <br />