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FOROFFICE USE: <br /> ----------------------- --- -----s.. '-= --.-._ APPLICATION FOR SANITATION PERMIT Permit No. <br /> ---------------------------_ --- ----------------------- (Complete in Duplicate) •, -�"„� <br /> --------------- - This Permit Expires I Year From Date k Issued ` ..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 AM— CATION_ <br /> Owner's Name .� <br /> -------------------------------- <br /> - -•- - <br /> "�} - Phone-_. <br /> Address------------------- tasr .. ' <br /> J--•---- <br /> f — --------------------------------- <br /> _b ----------------------------------- <br /> Contractor's Name"- <br /> Installation will serve: Re "--... .-- -.------ Phone...-------------_ <br /> ----------------------------------------------------------------------------------- <br /> sidence,®partment House E] Commercial Trailer Court <br /> " ❑ ❑i Mote! [] Other ❑ <br /> Number of living units: --- <br /> ( -_ Number-of bedrooms,�__ Number of bath Lot size / �// �?- <br /> Water Supply: Publ --------------------- <br /> ic system E] Community system ❑ Private ❑ Depth to Water Tabl <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ 'Sandy Loam ❑ Clay!Loam ❑ Clay ElAdobe ardpan ❑ <br /> - Previous Application Made: (It yes,date--------------------) No New Construction; Yes 2- No ❑ FHA/VA: Yes [],-`54o ❑ <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___,re.._-Distance'from foundation_f_ """".Materiah '"� }-�' <br /> n / No. of compartments------__.�_-___-__-"-SizeLiquid/ } q d depth -1/--- -------3'Capacity14�� <br /> Disposal�F^ield: Distance from near st well-!_Distance from foundation--- . !1_�---.Distance to nearest lot line <br /> Number of lines- <br /> Imo/ __-.-.-- Length of each line___ i <br /> - --------------- 9 - -------Wrdth of french.t9-- ---- ----- <br /> Type of filter material//Z-_-v -4Depth of filter material-,/_, CJ__ length""_�,,� -""__" _ <br /> Seep Pit: Distance to nearest well-------- -Distance from foundation-/- -----.Distance to nearest lot line----------- <br /> Number of Pits-----ryZ�---------Lining material_-._j-Ar4' ,, - Size: Diameter—­U <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----.--------------.--.----------- <br /> ❑ Size; Diameter----------------------------- -------Depth-------------------- <br /> - ------ ---------------------Liquid CapacifiY----------------------------gals. �. . ., <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building <br /> ❑ Distance to nearest lot fine------------------------------------= <br /> Remodeling and/or repairing (describe)-------------" ____v,4 ------- - -- 50rl_a_lx� <br /> -----------------•---------•----- + <br /> ----------------- <br /> - - - - - - <br /> ---- - ---- - • --- - - -- ----------- <br /> - - --- ------ ------ - - - ---- <br /> I hereby certify t I hav epared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State I and r e and regulations of the San Joaquin Local Health District. <br /> (Signed)-----..---" _ <br /> - - """"" - -- - ----- <br /> -- "-"- "-""_(Owner and/or Contractor <br /> BY; ------- ----------------------------------------------- <br /> l <br /> - -- ---- ---- ---- -- -- ------- --------------- -------------{Title]--- <br /> (Plat - .� <br /> plan, showing size I .. location of system in re a i n to wells, bu'dings, etc., can be placed on reverse side). <br /> FO RTM E35E NLY <br /> APPLICATION ACCEPTED BY <br /> --- -- ---- --- -- - ---- ---- -- - ---- - <br /> -- -- --------------------- <br /> DATE - - <br /> REVIEWED BY------------------------------------------ <br /> -------------- <br /> ------------- DATE------ <br /> ----- - --------- <br /> BUILDING PERMIT ISSUED--------------------------- ATE------------------- <br /> Alterations and/or recommendations:_ _,1 ----- L <br /> ..-----••------------------------------------- <br /> k <br /> -----I------------------------I-------- -------------- --------------7------------------------------ <br /> --- ---------------------------------- <br /> ------------------- <br /> ------- <br /> � <br /> ---------------------------- <br /> -------------------- ---------------------- ------------------------------------------ <br /> ---------------- <br /> FINAL INSP N BY:-- _----_. <br /> Date "i ------ ------------------- <br /> SAN JOA IN LOCAL HEALTH DISTRICT <br /> 1601 E.Ha:ellon Ave. 300 West Oak Streat 124 Sycamore Street <br /> 205 Wes!9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> E5 9 REVISED 8-59 3M 3-'63 F.P.D D. <br /> Al <br /> ;S <br />