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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 <br /> 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 /> Th is.application.is.made incompliance with County Ordinance No. 549. <br /> /J/AB Z.,,). <br /> JOB ADDRESS, AND LOCATION-_- ------- .-------------------- ------------------------_................. / <br /> Owner's Name yySN +. e ©©Q ,�/ ---------•--------••-•----• ------------------ ----------------------...._.. ----•---..-. Phone <br /> Address.......... / ? I!_- "' •- -----------------------�------------------------------•--•............................---•••......---------------- <br /> Contractor's Name----lam' ----------------------• ------------- ---------- ------------------- -._..... Phone................................... <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court (3.17 <br /> E Other ❑ <br /> Number of living units: --_ Number of bedrooms r__ Number of baths {?__-_ Lot size _-_;.:..........................•-----•-.---------------..- <br /> Water Supply: Public system ❑ Community system ❑ Private jg Depth to Water Table 0_ ft. t <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Ciay ❑ Adobe @ Hardpan ❑ f <br /> Previous Application Made: (if yes,date--------------------) No N New Construction:$Yes ❑ No R] FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: T <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---`-------i......Material---------------------.............. <br /> ......:....... <br /> ❑ No. of compartments-------------------- ----Size----------•-----------•---------Liquid depth_.----- ------ ---------Capacity....................... <br /> Disposal Field: Distance from nearest well-----------------Distance from foundation-.--_--.--+---..Distance to nearest lot line................. <br /> ❑ Number of lines-----------------------------------Length of each line------------------------------Width of french----•.......................... <br /> .... w <br /> Type of filter material.__.____-��-___.--.-_Depth of filter material <br /> - _..�.Distancetonearest lot line..��_-.__-._ <br /> length <br /> 1" <br /> Seepage Pit: Distance to nearest well-.2----------------Distance fro foundation� '--. <br /> ® Number of pits----X--------------Lining materlah&---------------Size: Diameter--.--'.j?-----------Depth-A .................... <br /> JI: ",AIN <br /> Cesspool: Distance from nearest well-----------------Distance from foundation---------------- Lining material_.--------.._-_--------_--_.---_•_-_. <br /> ❑ Size: Diameter---------------------- -•-------------Depth------------------------------ ------------------*Liquid Capacity---------------------------gals. <br /> Privy: Distance from. nearest well-....................__--.-_._.---_--.-_-----.-Distance from nearest building------------------..........----_------- <br /> Distance <br /> --- .--_-.-.Distance to nearest lot line--------------------------------------------------------------------- ' <br /> --------------------------=----------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):---. "_ ade! "+?''r...•-..: <br /> --- <br /> ...........................................•............--............................---------------------------- ------------•--••- - <br /> ..--_, <br /> ---------•---•-------•------------- ----------------•--.......-----•-----------.................-------------- ------- t� <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances,Afate laws, and rules and regal t' ns of the San Joaquin Local Health District. <br /> (Signed)--- --="------------------------------------------------------------- (Owner and/or Contractor) <br /> By:------------------------------------------------------------------------------- - ------------------.'-..---------------------••-•(Title)----------------_--------------- ---------------------- <br /> (Plot plan, showing size'of lot, location of system in relation to wells, b6ildings, etc., can be placetl on reverse side). <br /> i <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY- DATE -------- - - <br /> REVIEWED BY----------------- - - -- DATE....................................... <br /> BUILDING PERMIT ISSUED--------------------------------''----------- ------------------------------------------------------ DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:---------------- ---- ---------------•------••--•----•-----•-------...----------------••--------•-------------•--•....... <br /> --------------••---•------•----------••--------•-•--•--•--•--------•--•-------------------------------------------------------------------------------------------------------------------------------------•-----•----.------ <br /> I ..............•-------•----------------------------••-••----------•------- ------------•-- --------­-------- ----------------------------• ------....._................ ----------------------------------------------------- <br /> ------------ <br /> ------... <br /> FINAL INSPECTION BY:4 Zll�- .-.-. . ._..__._.. Date............. .... <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 6-61 ATLAS <br /> l <br />