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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> ___ _ ._.___ This Permit Expires 1 Year From Date Issued Date Issued ................. l_� <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. 49 <br /> JOS ADDRESS A LO�C�A•TION__ --------�._-)! ----- <br /> ��---���- <br /> Owner's Name--' 1� .. 1, ------------------ ------- � Phone..........- s <br /> Address__ <br /> 5 � ----- - ------ <br />' Contractor's Name-------- ... _ r --•- --- c?. t-----•-------------- - -------------- <br /> ---------- Phone....... ' <br /> Installation will serve: Residence III Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living unitsr'__. Number of bedrooms _ -. Number f baths ____d__ Lot size ..._ ------------ <br /> Water Supply: Public system Community system ❑ Private Depth To Water Table 6_____ ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam [-] Clay Loam Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date-------.------------) :No New Construction: Yes ] No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ` <br /> _ <br /> —.--,(No septic tank or cesspool permitted if public sewer is available within 200 feet.) ({� <br /> Septic Tank: Distance from nearest well_________________Distance from foundation-_-_________.__..-.Material-_-__ -__._____.......-._.---­------------------ <br /> No. <br /> __.---._..-----.___-.No. of compartments--------------------------Size-------- ------------------Liquid depth---------------------------Capacity----------------- ---- <br /> Disposal ield: Distance from nearest well_.�Q_/-._Distance from foundation-----.il._f?.........Distance to nearest lot line....s'____----- <br /> Number of lines.............I------_-------,- --_-_-_,Depth <br /> -- Length of each line----------�4-_____.._.Width of trench=___ '.�._..._�______._...-._______ <br /> Type of filter material._�Lf�.--___Depth of filter material-.___f J_/ -.....Total length-------- 4_________________________ <br /> Seepage Pit: Distance to nearest well---------------------- from foundation--------------------Distance to nearest lot line----------------- <br /> El Number of pits.-.- ------Lining material-----------------------Size: Diameter-----------------------+Depth--------------------------------- —4)- <br /> Cesspool- Distance from nearest well_________________Distance from foundation...-----------------Lining material..-___.________________________----- <br /> Size: Diameter-------------------- ----• -----------------------Liquid Capacity---------------------------gals. <br /> ❑ -Depth------------------------- --- <br /> Privy: Distance from nearest well__________________ _______________.__--_-_-..---Distance from nearest building:j----_-.--_-__________-------_-_____.__--. <br /> Distanceto nearest lot line- ---------------------------------------------•--------------•---------•-------------...-------------------------------------•-------------- <br /> Remodeling and/or repairing (describe):------- ------•-- --------------------------------- ------------------------------------------------------------ —= <br /> --------------------------------------------------------------•--------------------------------•--------------------•-------------•---- ...........__.--------------------------------•------- <br /> --------------•---------------------------------------------------------------------.-----------------------------------------------------------------------------------------------.......------------------ <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, SWOaws, and ruleAaregulations o the San Joaq Local Health District. <br /> t5i ned------_ --------------------- `c' 4---------------- ----------------- and/or Contractor) <br /> 9 �ey:.,.....- + --- ---- - -- - 9 ------- -------(Title)--------------`- � ----- ---- - <br /> '-. <br /> F (Piot plan, showing size of lot, location of system in relation wefls, buildings, etc., can be placed on'reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY- ---------------------------------------------- -------------- DATE---f- -/- `' ------------------------------------ <br /> REVIEWEDBY-------------•-•----------------------------------------------- ----------------------------------- ....... DATE------------------------------------------------------------ <br /> BUILDING PERMIT ISSUED - ------------------------------ DATE <br /> Alterationsand/or recommendations--------------- -------------------------------- ----------------------------------------------------------­--------•-------------------•-------------------- <br /> -------•-•-.-_---------------- 1-1---------- --------••------------------------------ ------------------------------•------------------•-------------------------•-------..-----------------....-......---------------------- <br /> i -----------------------------------•--------------------------•- ------• - -- ------------------------------ ------------•------------------•-----•------------•--•----------------------------------------------------- <br /> ' FINAL INSPECTION BY-.Z.-/41 <br /> Y- ------ ------ `- - ----------------------------- Date-_ -•----------------------- •-------- <br /> i <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 2M 5-62 ATLAS <br />