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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued <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.----- � � r..�---------- i •- -- <br /> -- --- ---------------------------------------------- <br /> Owner's Name----------------a..l-��'r-�t^---------- /�'i1� a---•--•------------- ----- - ---------------- ------- Phone------------------------------------ <br /> Add <br /> Contractor's Name----------------- -------- ------ ---- ----------------------------- ---------------I- --------------- ­­- Phone--------------------------•------- <br /> installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑® Other ❑ <br /> Number of living units: __/_.- Number of bedrooms _.�� Number of baths _C_____ Lot size _.. -- .-1- -_"------------------------- <br /> Water Supply: Public system ❑ Community sys ❑ Private �Repth to Water Table A.- ft. <br /> Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ 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---O- ance from foundation/4'Y A-_'-Material------------------------------------------------- <br /> No. <br /> .-_-----.---'---'----- --------------------- <br /> No. of compartments-_-"-- f _-__Size__T •X__3_.�_5.Liquid depth._________________Capacity----9-.�__- <br /> } r----------------- <br /> Disposal Field: Distance from nearestw L � Lance from foundation../-t.-�""l9istance to nearest lot <br /> Number of lines----------- <br /> ---Length of each line---------P70------------Width of trench----ao�{�-_-�_________-----_.- <br /> Type of filter material---_ _V—Depth of filter material--_.. `__ ....Total length-_-_---_---b---=A---01----------------- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation___..---_-__-----_-.Distance to nearest lot line----------------- <br /> El 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 /> Privy: Distance from nearest well---------------"____-----r__--1.._-_-----.----Distance from nearest'building-----------------------------------.------ <br /> ❑ DisF nce to nearest lot line-------------------------- ---------------------------------------------------------------------------------------------- <br /> ------------ <br /> Remodelingand/or repairing (describe):---- -- ------------------------------------------------------- -----------_-- •----- - ---•------------------------------------------"------------ <br /> r <br /> i + s <br /> ------------------------------- ---------------••-•-------- -------- -------------------•----•--•-•------------------------------------------------------------------------------------------------ - <br /> ! here y certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinanc h� � <br /> State laws, d rules and regulations of the San Joaquin Local Health District. <br /> (Signed -------------- ----------- IOwner, and/or Contractor) <br /> --*� <br /> (Title)_ <br /> (Plot plize oflot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> C]R-IL7 PART ENT USf ONLY j <br /> APPLICATION ACCEPTED BY-- DATE------ -- l - ----- ----- ---------------- <br /> REVIEWEDBY.-----------------------------------------------------------------------------------------------------------------------•--- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- <br /> Alterationsand/or recommendations---------------------------------------------- ----------------•--------------------------•-----------------••--------•--------------------------------------- <br /> ----------------------------------------------•------••-------------------------------- ----------------------------------------------------------...------------------------------------------------------------------------- <br /> ------------------------------------ ----------------------------•---------------------------------.---------------------------------_----------------------- ---- ---------------------------------------------- <br /> FINALINSPECTION BY:..------ --`-- ---- - ------ ------------------------ Date--------- ---- -------- ------- --------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Stroat 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M Rev{sed 8-'59 FP.Co. <br />