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r;.1K Vr�E�r Ubr <br /> - <br /> APPLICATION FOR SANITATION PERMIT Permit No. _.1_ ... ..D <br /> -----------------j-------------------------------------- (Complete in Duplicate) 3 / <br /> 1-3 <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 Ordin ce No. 54 <br /> JOB ADDRESS AND L CATIO n__D <br /> Owner's Name Phone <br /> = ----•-------------->- <br /> Address--------------- Q / _ <br /> ---------------------------------------------------...-• ----•-•---•-•-•-•-...... <br /> Contractor's Name---------------- i- _. . - - -------------------------------- - •-------- 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 _-- <br /> ..--•--------------- <br /> Water Supply: Public system ❑ Community system Z?'Trivate ❑ Depth to Water Tablett. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ <br /> Previous Application Made: (if yes,date----------- ....._..) No New Construction: Yes 9?"rlo ❑ FHA/VA: Yes R­—No ❑ <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 welf_-_��----Distance f�m foundation--4f-•______Mate aL_C.�-_ _ __ <br /> [&// No. of compartments.-----A-_----------__Size��_!„� -Op" depth__.�`�---_----Ca aci <br /> Disposal Field: Distance from nearest ell.___r"^.._Distance from foundation_. __ <br /> \ <br /> o ___-...__.Distance to nearest lot line____I <br /> [vim Number of lines----___ Length of each line------ _/ _._.Width of trench__..-1-------------------------- <br /> Type <br /> ___,_---_________________Type of filter materia&— epth of filter material_____-_______Total length____Ie-,"— ------_---- <br /> Seepage it: Distance to nearest well____ !r" -------Distance fr m foundation__---IV-------.Distance to nearest lot fine___1rs <br /> Number of pits-----A----.______Lining material_ _Size: DiameterDe th_ ' <br /> - ------ � <br /> /10*14..1 <br /> Cesspool: Distance from nearest well------------- from foundation--------------------Lining material-------_..-_.-__________--_____ <br /> El <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 /> 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 aniI:l regulations of the San Joaquin Local Health District. . <br /> (Signed) ---------------------(O� Contractor) <br /> ------------ <br /> Ely:---------------------------------------------------•-------------------- ---- '-----------------------(Title)---r <br /> .a <br /> (Plot plan, showing size of lot, location of system h relation to wells, buildings, efc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------I"-' �------ --------- DATE �' -�t-- <br /> - ---------------------------- <br /> ItEVIEW'ED 8Y------------------------------------------------------------------- --------------------------------- -------------------•--- DATE---------- <br /> BUILDING PERMIT ISSUED---------------- --------------------------------------------- •------ DATE--------------------------- ---------------- <br /> Alterations and/or recommendations:_ I_.� ,_- - fG► �, j _- A s_s.__.._I_ <br /> AQ , i a '',----- ------- to i---� <br /> S _ <br /> -- 0---' - ) - ---- ._ .------------------------ -- - ----- -- --- ----- ---- -------- ---- ------- <br /> FINAL INSPECTION BY:--- -- Date---- <br /> ------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT/ <br /> 13LI south American Street 300 West Oak Street r 124 Sycamore Streit 205 west 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES-9J REVISED 9.59 F.P.CEI,2M 6.60 <br /> t P! Y I <br />