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FOR OFFICE USE: ' <br /> --- - Permit No �j <br /> APPLICATION FOR SANITATION PERMIT /� ---f•-"•-•- <br />----------- --------------------------------------------- (Complete in Duplicate) Date IssuedZ 3 <br /> _..........----..." -------- This Permit Expires 1 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 549. ` <br /> JOB ADDRESS AND OCATION ` r - --------- ----- E ..... <br /> Owner's Name._. -- --- ••--------------•--X------ --------- - --------------- <br /> ----------------- Phone........--------------_---------- <br /> % <br /> ,� .--.. - -----------------•------•j <br /> Address.............--- •--•• ------ •- - - - - - `.�----------------------------- <br /> Address <br /> . <br /> Contractor's Name---•• �1 �...._. - P o e <br /> Installation will sere : Residence 2 'partment House ❑ Commercial ❑ Trailer Court ❑--------- <br /> Motel ❑ Other ❑ <br /> Number of living units: J. Number of bedrooms .-,-?,N mbar of baths ---/. Lot size _ _ --•--- <br /> Water Supply: Public system ❑ Community system ❑ Private Depth To Water Table ....... it, <br /> Sand Loam Clay Loam ❑ Clay ❑ dobe( Hardpan ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ y ❑ Y <br /> Previous Application Made: (If yes,date"-"_---------------) No [ New Construction: Yes. o 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 /> Sep . Tank: Distance from nearest well__.4 _--Distance fAm foundation----/ a_ <br /> No. of compartments--------- _---Capacity.. <br /> Size_ ' .?-�Y�ezLiquid depth <br /> Dis osal Field: Distance from nearest well.. .."Distance from foundation-._1 -�..__.Dis+ante to nearest lot line_..,--.— <br /> 19 Number of lines-----------•-----------------------Length of each line----.-•-------------.--------Width of trench." .�. --••�---••-- �, <br /> Type of filter ----Depth of filter material-----1-,P____"`----Total length---.. <br /> Seepage Pit: Distance to nearest w ll..11. "-.------Distance from foundation_--•_l __�_.Distance to 5earest lot line--_ _�... <br /> Number of pits-------- -___-____Lining material.._ p_F�__.Size: Diameter-'�XeVk Depth_..-1 �___________________ <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 to 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 fi <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health JDistrict. ' <br /> (Signed) -- --/-t- E�� ---- -----------(Owner and/or Contractor) <br /> --- <br /> BY= --- (Title)----- �"�- --------- \ ^J <br /> (Plot plan, showing size of lot, location of system in relation #o walls, buildings, etc., can be placed on reverse side). �Il <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY- -- -- ---- - ---- ---- --- --- ------------------------------ -------------- <br /> REVIEWED BY------------------------------------------------------------------- ------------- -• ----------------------- <br /> ------- ------ DATE------------------- <br /> - --- ------------ <br /> BUILDING PERMIT ISSUED---------------- ------ ------ --------------•-•------ DATE ••---• --- <br /> Alterations and/or recommendations:._ ___ " `" <br /> -------------------------- -----•------ ---------------------------------------------------------------------------•-•--------------------------------------- <br /> ------- -----------­----------- --------------------------- ------- <br /> 0.4 <br /> 7�7 <br /> FINAL INSPECTION BY:_�..- -•------ -------- --• ------- --- Date --- ----- ... ... +- . .. ------ ------------ <br /> SAN JOAQUI LOCAL HEATH DISTRI <br /> 130 South American Strout 300 West Oak Street 124 Sycamore Street 305 West 9th Street <br /> Stockton,California Rodl,California Manteca,California , Tracy,Colifornio <br /> ES 9 REVISED 8-59 2M 5-62 ATLAS <br />