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mJKUr-K-t USE:., <br /> 1 rt y �°- ..- _'.�____- APPLICATION FOR SANITATION PERMIT <br /> --------------------------------------------------- ----- (Complete in Duplicate) <br /> --- . ------ This Permit Expires I Year From Date Issued Date Issued ........./__.___C........ <br /> j <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 Ordinanc No. 9. <br /> Od _ r <br /> JOB ADDRESS AND LOC TI. N............ <br /> Owner's Name. 1. ---•----------------•--------------------.... Phone--•-•------------- <br /> Address--------- <br /> --- •---- / <br /> Contractor's Name..........--... _ Phone.-,............ <br /> Installation will serve: Residence ❑ Apartment House E] Commercial L] Trailer Court C-] Motel ❑ Other EEF <br /> Number of living units: -1/---- Number of bedrooms .. Number of baths *.. Lot size -_ .eon '•--•--•.____-____•--_--_•-_ <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -6Q_ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay ❑ AdobeHardpan ❑ <br /> Previous Application Made: (If yes,dote----_--------------) No New Construction: Yes [tEr"No ❑ FHA/VA: Yes ❑ No @9-- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 'I <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank Distance from nearest wel6 p_�_-____ 1 <br /> - - Distance from .............Material.l_�--.�.... -._._�'-_-•-- <br /> .................... <br /> UK No. of com artments.. Capacity <br /> p Size �. Liquid depth- ... -- ---•� Q <br /> E � >• <br /> Disposal Field: Distance from nearest well '`(9-- __--.Distance from foundation�d� ......_.Distance to nearest lot <br /> Number of lines---------_ ............. Length of each line.----,/ --------------.Width of trench._�r•. __ <br /> Type of filter material.`0! �....-_ / $' �� � <br /> Yp �`i/-- Depth of filter material-------------------- -Total length..., .-•------_._..__--•-------------- <br /> Seepage <br /> ----------Seepage Pit: Distance to nearest well-A0O-------------Distance m foundation..,(1T.-��s�►'�+-.Distance to nearest lot fine-?! <br /> Number of pits....-..I------------Lining material.,el- .C4-._-Size: Diameter_.;A, Depth-.-A_L.!`r ......... � <br /> Cesspool: Distance from nearest well.....------_--.Distance from foundation-------------------.Lining material_.....----..--.---_-----.-_..._...... ID <br /> ❑ Size: Diameter. -•----Depth-------------------------------------------------..-Liquid Capacity.- gals. ; <br /> Privy: Distance from nearest well--------------------------------_-------_--- <br /> .._Distance from nearest building..................................... <br /> El Distance to nearest lot line---...-.._......................... <br /> Remodeling,and/or repairing (describe)------------------------------ <br /> •------­----------------------------------------------------------------------•------------------------..---- ------...----...--------------•------------ <br /> -----^------------•-------•------------------------------------.•--•---•----•----•------._ F i <br /> --------------------------------------------4, 17 <br /> ---•-- ........---..._-------••-----•-`---•----------'...-_...-----•-----...--------.��-.._.-----------..............-._--•-----•------------------ <br /> I hereby certify that I havth plication and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rull sof the an Joaquin Local Health District. <br /> (Signed)----------------•-----------•••-----•--- ---------------(Owner and/or Contractor) <br /> gr--•-----••-------••--....-•--------- y rifle -------------------- <br /> (Plot plan, showing size of lot, lsystem in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.... <br /> - - -----•'--..--.-.- <br /> ----------- •-------------------------- DATE <br /> J,1_'_J ................. <br /> BUILDING PERMIT ISSUED ..Y_?_�­ <br /> --------------------------------------- DATE-------•----•--------------•-- <br /> ---------------•--- <br /> fffll8t om[ <br /> --- ---- <br /> DATE <br /> __ ------- ------ <br /> A er Tions and/or recommendafions:_ I &. - ....--------.................................................. <br /> F1NAL INSPECTION BY.. ------ --- -------=----------- ----------- Date----- <br /> ��� <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 144 Sycamore Street <br /> 405 Watt 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 @M 6-61 ATLAS <br />