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_FOR OFFIC� USE: <br /> --- ---------='4 APPLICATION FOR SANITATION PERMIT !z.- 1 �5 <br /> ------------- ------------------------ - {Complete in Duplicate) L <br /> ....r----- Date Issued <br /> ��---��- -�- ---------"--- - This Permit Expires i 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......... <br /> 3 <br /> .---------- <br /> Owner's Name.. ----- - _ r ........... �. --�- hone_ - d -- <br /> Address.............. <br /> Contractor's Name................ M <br /> -••---•------- • ------ ----J ------------------------ Phone................................... <br /> Installation will serve: Residence EN Apartment House ❑ CIE mercial [3Trailer Court [-] Motel ❑ Other ❑ <br /> Number of living units: ./--- Number of bedrooms ._ _ <br /> - _ lumber of baths ---Z. Lot size ........... -�_Ysx._�--•_-__-- <br /> � N <br /> Water Supply. Public system ,4 Community system C] Priva a ❑ Depth to Water Table _X-41t. <br /> Character of soil to a depth of 3 feet: Sand JOGravel,❑ Saindy Loam ❑ Clay Loam E5—Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: {If yes,date. 01 No ❑ New Constructi : Yes ❑ No [X FHA/VA: Yes ❑ No M <br /> TYPE OF INSTALLATION AND SPECIFIC A IONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> � V <br /> SFptic Tank: NDist of coin arance from nearest._Wel2-----_ D Bance[from foundation-___--_,.ae__.Maferial_____�-�,,,,:�T�•�. <br /> p - :�&,/j—Liquid depth--- ,�� ----•-------Capacity------ = <br /> Disposal Field: Distance from nearest well. ----Distance, from foundation___�o__.___-Distance to nearest lot line.....?--!._. <br /> ( Number of lines............. _. g <br /> "-•---Len th of each line--------���e1-,---- -Width of trench---------7 ..____-----• <br /> Type of filter material..A,.r__.__�_.Depth of filter material.__!'_ Total length______________f€_/_.4--- ......._..__ <br /> Seepage Pit: Distance to nearest well------- _...Distance:�from`foundation____.e�._. Distance to nearest lot l <br /> Number of pits--------rf___..._____Lining material.- Diameter_ -" ..._.Depth.__.___-__.7.4`.-_____- <br /> Cesspool: Distance from nea-rest'well_._____�__._._.Distance�from foundation--------------------Lining material..................................... i <br /> ❑ Size: Diameter--------.-•---------------------- r._Depth---- - -----------------•-----------------------Liquid Capacity <br /> Privy: Distance from nearest well_______________________________t�-__---------Distance from nearest building------------------------------------------ <br /> --­--------- <br /> El <br /> ______..__________•-_-___._--.._ <br /> ------ i <br /> Distance to nearest lot line-----------_---------•------ �y <br /> Remodeling and/or repairing (describe) ________________________________-.___- ---_ ` <br /> ------•--•----------------•-------------•------ .................................. <br /> -------------------•-------•----•------•-------- <br /> S <br /> ___________________ __ ________--. _ _ ..___.____.______-.--_____.-_..__________--__�____....____________-_____-___ <br /> . I hereby certify that I have prepared _-----------------------�=-----------------------••----------•-•--••-••---------------------------•-----------------••---------------- <br /> ed this application,and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San-Joaquin Local Health District. <br /> (Signed) ;= ----- "•-------------------------------------------------------------(Owner and/or Contractor) <br /> By:.. •� -- ------/ �� - (rifle)----- -' ------------------------------------------ - -... -------------- <br /> (Plot plan, showing size of lot, location of system in relatio to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEP RTMENT USE ONLY <br /> APPLICATION ACCEPTED BY rte............... <br /> ............... <br /> DATE----------- d __. <br /> REVIEWED BY ----- - - • ---------- M ------------ - DATE <br /> BUILDINGPERMIT ISSUED--------------------------------------------------------------A------------------------------------ DATE. <br /> Alterations and/or recommendations:-------------- ----------------------- 'IM i <br /> -•-------•-•--------- ------------•--------•---------- <br /> ------------------------------------------------•---•----------•--------- ------------------------•-------=M....................-------------------------------------------------. •------------------------------••----- <br /> ----------.-----------••------------------- '---------------- <br /> ----.......__._...---•-----•-•----------•----------------- ------------------------ . <br /> ------.." ------- --------- -----------•-- ----•--------------------•-- ----- M <br /> -•--•-----------------------__----------- --- <br /> 1 <br /> FINAL INSPECTION BY: Date '-- <br /> :.. <br /> '' ----------- <br /> -SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycomore.Street 205 Wast 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 5.59 2M 5-E1 ATLAS <br />