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-----------------------------------_------------_------ <br /> --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ....l:�_��L) <br /> -------------- ---------------- ----------------------- (Complete in Duplicate) <br /> ------------------ --- --------------------------------- This Permit Expires 1 Year From Date 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 AND LOCATION---•---1. ./k- ••-_ _ ---------/,r/,............ <br /> - <br /> Owner's Name_.. , _- --,,�, �L2 'Z <br /> Address -- •--- li � <br /> ----------•-- ane. --- <br /> .... <br /> Contractor's Name..... --T.J------------ --------------- Phone......•----•---•--•---• ....... <br /> Installation will serve: Residence [,'Apartment House ❑ Commercial Trailer Court Motel Other <br /> Number of living units: ___1_.. Number of bedrooms .3_ Number of baths .,2,- Lot size ... „_•_ <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ..lit. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date____________________) No ® New Construction: Yes M—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 /> i <br /> Septic Tank: Distance from nearest well-0­1�7_._----_Distance from foundation...7A-----------Material---- <br /> [ compartments <br /> -l......No. of compartments.__` _ <br /> _ ______- __._Size_....___ x�t �C_ <br /> Liquid depth--•-----��-�---�--------•-•-Ca..P..ac...i.t.y....... <br /> ._..P....'Q..Q... . <br /> ......... <br /> � <br /> Disposal Field: Distance from nearest well__U�_r._____Distance from foundation----- ---__Distance to nearest lot line.... `� <br /> _...... <br /> ❑'' Number oflines-------------�--------------._Length of each line--------Aa----------------Width of trench........Aj�.'__s <br /> --------------- <br /> Type of filter material.-..._. _o_c-lr___Depth of filter material_.---/A?'_.__________Total length------- _! - --------------------- <br /> Seepage <br /> ----___!---- _- <br /> See a e Pit: Distance to nearest well_-__L6�%_.� <br /> P 9 ____.Distance from foundation----Za-'--_.....Distance to nearest lot line..ss _...... <br /> Number of Pits____-_�_.-_____Lining material._.____.A'_,(__.Size: Diameter-----3_x?_"______Depth-------_----- _---•„- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------.-----Lining material...----------------------- --------- <br /> ❑ Size: Diameter Depth Liquid Capacity... .--------_-•-••-galN., <br /> Privy: Distance from nearest well__________________________________-------------Distance from nearest building_______.._________..._______. _--------- <br /> 13 Distance to nearest lot line. <br /> Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------------ <br /> ------------------------------------------------------------------------------------------- <br /> --------•---------------•------------•----------------••-------- --------------------------------•----•--------------------------•--------------••--•-----------------•---------•---------------•----------------- <br /> I hereby certify that4ann <br /> d t s application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, ang ations of the San Joaquin Local Health District. <br /> (Signed} -- -- ---------• -------------------- -•-------------------•-----------------------------.-•-----------------(Owner and/or Contractor) <br /> gy:-•-•-----.-....-•--•-••••-- ----------•----•------------------------------------------------- _-= -=-------.(Title)--_---- _----- ------------------- <br /> (Piot plan, showing size of lot, location of sy tem in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------------------------------------------------------ �J �� �------- DATE------------------ <br /> REVIEWEDBY---------------------------------------------------------------------------------------------------------------------------- DATE. <br /> BUILDING PERMIT ISSUED---------•----------•---------------•-------------------------------------- ---------• DA•TE_._. <br /> Alterations and/or recommendations_________ ____________________ <br /> _P?Z.-_�l---- ---- ----- ---©�� ����------------------------------ <br /> ..........................................................-•--------------- -------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------- --------• --•---------------- - ---•------------------------------- <br /> FINAL INSPECTION BY:___-...._--.- - <br /> --, - -----------------•-••-----------•- -- Date-----------•-------- -•---- -•• - --- ---.••--------•-• <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Stmt 300 West Oak Street 124 Sycamore Street 205 Weft 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> EB 9 REVISED 8-59 pM 8.51 ATLAS <br />- - t <br />