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a,, 4 <br /> I APPLICATION FOR SANITATION PERMIT Permit No. ..l. .b_�__ __ <br /> (Complete in Duplicate) 3-16 <br /> This Permit Expires 1 'Year From Date Issued Date lssued`__�S________--------- <br /> l 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 /> JOBADDRESS AND LOCATION-Di------ ------------ - - - - - -------------------------•-------`-------- ---------- - --------------------- <br /> - <br /> l...... h.. <br /> Owners PKName-------•--- '._w,`W"'".�'"' °n <br /> Address ----------------------------------------------------------------------=-----------------:...---------------- <br /> f <br /> Contractor's Name-------------"----------• I-- --------- Phone..--------------------------------- <br /> Installation will serve: ResidenceW Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ___tiNumber of bedrooms ___� Number of baths _/_ Lot size ---------------- _3�-___----- _ P___________ <br /> � , F.+�-�.++..�.r•-'..-.Y..�..ram-.+`.r....-�...n„�............. <br /> Water Supply: Public system ❑ (Community system 'El Private Depth to Water,Table __ ____ ft. <br /> L Character of soil to'a depth of 3 feet: Sand ❑ Gravel ❑iLSandy Loam ❑ Clay-Loam ❑ Clay ❑ Adobe F1 Hardpan [] <br /> t Previous Application Made: Yes ❑ No JR New Construction"Yes�4'-Nt-ff­ FHA/VA: Yes ❑ No- <br /> j TYPE OF INSTALLATION AND SPEC IFICATIONS: y� ' <br /> (No septic tank or cesspool permitted if public sewer is,a_vailable within.200.f-eet.), _ j <br /> Septic Tank: Distance from nearest well------------------Distance frorn foundation-------------------.Material--------:._'------------------------------------ <br /> No. of compartments-------------- r <br /> ----------- Size-------- --------------Liquid depth-------- ' - ---------Capacity---------- ------ --- <br /> I Disposal Field: Distance from nearest well Ttorn foundation_-__:,./_�_.______-Distance to nearest lot line_ <br /> Number of lines---- `--__ ._____"_�_:L gth of each line-----� �------------Width of trench------�.�--------------------- (� <br /> Type of filter material-_"_ Qom__ Depth of filter material--__J. �_ Total length__--__{� O u Q <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation___.. I-----------Distance to nearest lot line__-_______--_--_ <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diamet6r-----------------------Depth-------------------------------------------------------- <br /> ` Cesspool: Distance from nearest well-----------------Distanc6 from foundation-----------.--'-.Lining material...-...-"._._____"..____-_-_.--_--- <br /> r [] Size: Diamefer--------------------------------------Depth- -' ----------------Liquid Capacity---------------------------gals. <br /> Distance from t __ __Distance T <br /> Priv Distance to nearest lotwnle__________________" _._______ frbm nearest building__,....__.______________._.____....__._. <br /> y <br /> 0 4 <br /> -----------4--------------------------------------------------- <br /> Y <br /> RemodeGn and/or re irin describe : ---------- <br /> -------- :r - - -------- <br /> - - ----- ----------- w <br /> ------•---------- <br /> --------------------------- <br /> --- --------------------------------------------------=- ---- =--------------------------------------------------------------------------------------------- ------------------- ------------------------- <br /> r _ <br /> f hereby certify that l have epared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, andel rules and regulations•of the San Joaquin Local Health District. $ <br /> Si Heel -dV- - --------------- --=--------------------------------- -------------------------------- ------------,-------(Owner and/or Contractor] . <br /> �. ( )--------•------- <br /> 9 <br /> _ by:------------------------------------------------------------------------------------------------------------------------------------(Title] � }----- ------ ---------------- <br /> (Plot <br /> ----- ---------(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can 6e placed on reverse side). <br /> { FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------------------------ --------------------------------------- DATE------------------- ------------------------------ <br /> - <br /> REVIEWEDBY ------------------ -------------------------- DATE---------- �-f--------------------------- <br /> BUILDINGPERMIT ISSUED-------------------------- -----------------------------•------------------------- - ::_:: DATE._ -- i--------------------------- <br /> ,4 _ ._.-.._--" _T <br /> lAlterations and/or recommendations:------------------ -------------------- ----------------".•--------------------------------------•----------•------------ -•---•-----------•-----.-.----------- <br /> -----------------------------------------------------------------------------------------------------------------------------------------------------------•---•--•-----------"-------------------------------------- <br /> E <br /> _.._-.--__.___"________________"_-._.______--_-_____---___k._..______.-_____"_._.--_____..______"--._-.___"_____-__---______"""_"__------"______"."_"_-.."---__---______._...___-.-"-"._.--.___.____.._.-____-__--_..___-__-- <br /> I s, <br /> // DL INSPECTION BY:FINA <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> k 130 South American Street 300 West Oak Street' 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> :1 <br /> ES-9--2M Revised 8.'59 F.P.CD. <br /> 1 <br />