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�1 APPLICATION FOR SANITATION PERMIT Permit No. .../.. 3_2-_7 <br /> 1 / <br /> (Complete in Duplicate) Date Issued <br /> 1 <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 <br /> County ,Ordinance Nd 55499 <br /> JOBADDRESS A OCATI --/----•Z�- fz' -- - ... `------------------------------------------------------------------------------------------------- <br /> � p -----• •- <br /> -------- -------------------------------------------- <br /> Owner's Name__.----. -------- Phone <br /> AddressPi ---------------------------------------------------------------------------------------------------------------•----------- <br /> Contractor's Name---------------- ----- Phone <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ # <br /> Number of living units: __._____ Number of bedrooms _ _____ Number of baths _,/___ Lot size ___76,__— f <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table elft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam ❑ Clay Loam ElClay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: Yes E] No New Construction: Yes E] No �F{A/VA: Yes ❑ No gam' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic.tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Salic ,Tank: Distance from nearest well_________________Distance from foundation_____--__--____.__.Material------------------------------------------------- <br /> No. <br /> _____.______-_-- -____- ____________._.____----.No. of compartments--------------------------Size----------------------------,---Liquid depth------------- ------------Capacity------ ---------------- <br /> Disposal Fieldk Distance from nearest well.________`....Distance from foundation____� _("_.Distance to nearest lot line---n0 _�..- <br /> /' �r Number of lines_ _______ ___________ _________Length of each line___ k�-�-- ___ .Width of trench---�, "` <br /> !/ r L /r r <br /> �� of filter material/_,ir_�� Depth of filter material--_ Total Total length___.__ r1______--------------------- <br /> Type <br /> Seepage Pit: istanee to nearest well_____- __---___Distance m fou dation_____ .2 "-.Dista ce to nearest lot line_.-_�____- <br /> ,((%%�� I ------------ ! <br /> �.O1,YI��umber of'pits.-t.._.-_�-------- g CSize: Diameter-----�'�---------Depth---ytr`�_�------ �j <br /> ��ttr __Linin material___ ��� <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material___.___..____-_.---.__.______________- � F <br /> ❑ Size: Diameter__'-------- <br /> --- -4f---- -------------------Depth_------------------ ------------------ -------------Liquid Capacity-.-.------------------------gals. t''1 <br /> Privy: Distance from nearest well- _____________________________________Distance from nearest building_____...__________-_---_--.-__.____.-____. <br /> C] Distance to nearest lot line--------- ----------------------------- ----------------------- ------------ --------------------------------------------------------- �. <br /> Remodeling and/or repairing (describe)_________ _____ - -__ _____ <br /> Is ---- -------------------------------------------------- ------------ <br /> i <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, State laws, and rules and re ulastions of the San Joaquin Local Health District. <br /> (Signed) .; m --------I----- ---- ----------- -- <br /> ------------------------- Contract ) <br /> __,�»,n..- , <br /> }- <br /> BY� --- --- ----- {Title)- <br /> .................. <br /> (Plot plan, showing size of lot, location of em in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BYa ----- --- - ---- ---- ----, --------------_ - : DATE ----------------------- <br /> ' <br /> ---------- <br /> REVIEWEDBY '----------- DATE------------------------------------------ ----------------- <br /> BUILDING PERMIT ISSUED = `------------------------------------------------- DATE <br /> Alterationsand/or recommendations:------- ----- --- ---I--------------------------=------------------------------- •-------- ----------------------------------------------------------------------•---------- <br /> I ._ <br /> --------------- ­ - <br /> --------------------------•-- --------------------•----------------•------------------------ <br /> ------------------•--------------------------------------- ------------------I-----------------------------------------------•--------------------------------------------------------------•----- <br /> I --------------------------------------------------- <br /> ---- ------------ ---- <br /> I J <br /> FINAL INSPECTION BY------------- - ----- •--- --------- <br /> ------- -- •----- Date-----------�-1- �---- ------------------------------ <br /> SAN JQAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Was+ Oak'S+roof `. 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M Revised 8-'59 F.P.Co. W <br />