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1 � <br /> APPLICATION FOR SANITATION PERMIT Permit No. .___l1. 1. . _.- <br /> (Complete in Duplicate) Date Issued 3--------------------k J <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 Cl y O dinance No. 549. <br /> JOB ADDRESS AND LOCATION ------S. ��' <br /> ----------------------- ---------------------------- <br /> -�--�' •- •r `+ . Phone <br /> Owner's Name------------------- •- -•--- - ¢ Z <br /> Address------------------------------------- --------- --------- --------•--------------------------------------------------------------------------------------------------------------._.. <br /> Contractor's Name------------------------------------------------ -------- ••--------------k-------------•---•--- Phone--------•-----------------•-------- <br /> Installation will serve: Residence`' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -_Q--- Number of bedrooms .�-- Number of baths/20�0+ size -- - - ------ -------------------- <br /> -------------------- <br /> Water Supply: Public system �Z Community system[❑""Private❑'"Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: 'Sand E] Gravel E] Sandy Loam 0 Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: Yes ❑ No ® New Construction: Yes,[A No ❑ FHA%VA: Yes ❑ No [K <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> { ptit <br /> No se tank or cesspool Permitted if public sewer is available within 200 feet.} <br /> � eI <br /> Sepfic Tank: Distance from nearest well__.--�rJ�.Distance from foundation-----,/-d-----.Material-_ .-.- .__:- ----------- <br /> -�ac�No. of compartments--------------- -- Size---,grl'-f -------Liquid depth---------- .---------Capacity-- - _ ___ <br /> Disposal Field: Distanceifrom nearest well-_-.-9fl.--Distancefromzfoundation-----/-0_---.Distance to nearest lot line_---_--` -.. <br /> Number of lines_�'_-------------3--.-----------?L'ength oft`eacli line----_-_-��_------------Width of trench---------,� ---------------- <br /> Type of filter material__ ,..__--Depth of filler ----Total length------------A_=L_2�?--------------- V� <br /> Seepage Pit: Distance to nearest well----------------------Distanceifrom foundation______._.--___-._--Distance to nearest lot line---------------.- <br /> tvd <br /> ❑ Number of pits----------------------Lining material------------ -------- Size: Diameter---------------.-------Depth-------------------------------- <br /> Cesspool: Distance from nearest well-----------------DiO ncelfrom foundation------------ ------.Lining material--__-..-_-----..__--.---.--------.-.-. <br /> ❑ Size: Diameter------------------------- ------- ----Depth---)------------------------ %------------------Liquid Capacity--------------------- ------gals. <br /> Priv Distance from nearest well - <br /> y. •► 4` Distance from nearest building---------------------------------------- r <br />' ❑ Distance to nearest lot line----"`-' -'---- ---`----j�--------------------------- 1 ----------------------------------------------------- <br /> Remodeling and/or repairing {describe): -----------------•--`•-------------------------- -------•------------------------------------------------------- <br /> ----------------------- <br /> I <br /> I hereby certify that I have prepared this application and than the work will be doneiin accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> I <br /> (Signed}_,�---- {Owner and/or Contractor} <br /> r ----- <br /> Y - - -- - - .. - - --- ---- �,...--�-- ^----,g--�--------•(Title)---==-------- -- - ---- ---- -------------------- <br /> B -------------------•-•--------- -- --- -----' ----- -- --- an 6�e placed on reverse side). <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., c_� <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----- DATE.-- ' ��' <br /> REVIEWEDBY--------------------------------------------- -----------------------_-------------------------- --------------------------- DATE------------------------------------------------------------ <br /> BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ <br /> DATE------------------------------------------------------------- <br /> Alterationsand/or recommendations------- ----------------------------- ----------•-•--•----------------------------------•----------••-------- ---------------------- •------------------ <br /> ---------------------------------------- ------ - --------------------------- ---------------------------------------------------------------------- --------------------------------------- ----- -------------------------- <br /> - - --------- <br /> ----•-------------------------- ------------------------,�------------- ---------- ----- -------- <br /> FINAL INSPECTION BY-------------- ,� ��'s.- ----------------------------------- Date- -------------�5-----`T` ------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Streot 132 Sycamore Street 814 North "C' Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M Revised 6-'59�.P.Co. - <br />