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1 APPLICATION FOR SANITATION PERMIT Permit No. ...... -�.± <br /> (Complete in Duplicate) ( /y <br /> This Permit Ex ires 1 Year From Date Issued Date Issued _____J-C---_.!_____.. U <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 l y� my Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION.-- - <br /> Owner's Name .. Phone <br /> ,�i ---•--- <br /> Address-----------_----Vlf.-n. � �ZUl�r.i!_�7n.• <br /> Contractor's Name- •-------- / ------•--..._---- .... = Phone <br /> Installation will serve: .,Residence g?"7partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __ __ Number of bedrooms 'Number of baths ___?_ Lot size ___a __ ____-______________.___- <br /> Water Supply: Public system W111,q,_0rnmunity system ❑ -Private ❑ Depth to Water Table -fa"ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe @Er"'Hardpan ❑ <br /> Previous Application Made: Yes ❑ INo V?-'New'Construction: Yes ❑ No FHA/VA: Yes ❑ No E­— <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <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 /> ,ffkj6fj21 No. of compartments--------------------------Size-------------------------------.Liquid depth------------------------._Capacity------------------ - <br /> i <br /> Disposal Nuld: Distance from nearest well_---...�------Distance from foundation_____Z,O---.-.-.Distance to nearest lot line___%O~------ <br /> ; �lJ Number of lines----------- ----------- Length of each fine---= - ------.Width of french------- <br /> �- Type of filter material,- f�/ !_Depth of filter material____,! °/__Total length_________ ----------- ------- <br /> Seepage Pit: Distance to nearest wellr__ ---------Distance fr fo dation-----,� ._____.D t s�e to nearest lo}�line__` _✓_._. <br /> Number of pits------,�_._________Lining material---�4. .Size: Diameter_-_ �__________Depth_____.. A;--�___r----------------- <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 /> El Distance to nearest lot line--------------- ------- - ----------------- <br /> Remodeling and/or repairing (describe}:--- - ! ------------------------------------------------------•------------------------ <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -- <br /> - ---------------------------------------------------•----------------------------------- ------------------------------------------------------•---•----------------------------------------- ------------------------------ <br /> I hereby certify that I have prepared this application and +hat the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and raga #ions of t*Joaqui,Sanocal Health1)is#riot. <br /> Si ned ---------- --------------------------- Contractor( g )--------------------- ) <br /> By:--------------------------------------------------------- --- I-----------------(Title)-------( L ,�LI ./ ------- --------- <br /> (Plot plan, showing size of lot, location of m in reildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY__ _�_,__G-------- <br /> . <br /> -t � <br /> - -----------------------------•------------------------ DATE--------- fit' ------------ <br /> REVIEWED BY--------------------------------------------- --------------------------- --------------------------------------------------- <br /> - DATE------------------------------------------------------------ <br /> BUILDING PERMIT ISSUED--------------•--------------------------------------------------------------------------------------- DATE-------------------------- t <br /> Alterations and/or recommendations: <br /> :::: ::::G_--_ - <br /> ----------------------------------------------------------------------------- ---------------- --------- --._..------------------------------•-------------------- ------------------------------------------------------ <br /> FINAL INSPECTION BY:--( ` - _� ����•t Date--------------�'_–1 <br /> SAN JOAQUIN LOCAL HEALTH.DISTRICT <br /> 130 South American Street 300 West Oak Street :k r ,..4132 Sycamore Sfreef, 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> FS-9-2M Revised 8-'59 F.P.Co. 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