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r'v��i• l.t USE: <br /> -------------------------------------------------------- f <br /> APPLICATION FOR SANITATION PERMIT Permit No. _. -� <br /> rf---••�---•- <br /> - = ------ (Complete in ]Duplicate) <br /> This Permit Ex fires ] Year From Data Issued _ <br /> --- - .3 <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 /> This application is made in.compliance with County Ordinance No. 549. <br /> JOB ADDRESS AN CATION-_!. �� a <br /> / 1. = .- <br /> wner's Name--...- --------------------------------------------------------------­------- <br /> .............. -•--- Phone.---- <br /> •---•-•----------------•--- <br /> Contractor's Name—... � . --- <br /> ---- - - Phone <br /> • _ '.. <br /> Installation will serve: Residence <br /> Apartment House ❑ Commercial <br /> ❑ Trailer Court [] Motel ❑ Other ❑ <br /> Number of living units: /-- Number of bedrooms Z__ Number of baths _ <br /> /.-- Lot size ....... <br /> Water Supply: Public system ❑ Communitysystem Y stem <br /> ❑ PrivaDepth ro Water Tables-1? ft. <br /> Character of soil to a depth of 3 feat: Sand ElGravel ❑ Sandy Loam El ClLoam ❑ Clay El <br /> Hardpan ❑ <br /> Previous Application Made: Ilf yes,date--------------------I No ❑ New Construction- Yes ❑ No>(. FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ` <br /> (No septic tank or cesspool permitted if public sewer is available within 2Do feet.) <br /> t a Distance from nearest well"---------------- <br /> Distance from foundation--•-----,-----•----lvlateriai------.---"---_----•......................•-•--- <br /> No. of compartments--------------------------Size-------------------------------.Liquid depth_-- ----Capacity <br /> Disposal field: Distance from nearest well-�"'Q�.._.Distance from foundation.. <br /> �t -___--_.Distance to nearest lot line <br /> Number of lines--)---- ------ ---- - -•-- --Length of each line------ -[rf------•--- .Width of trench----s"1,. _ ____ <br /> Type of filter material. t- Depth of filter material-_ `� <br /> r� Total length-----------------­­ <br /> ­14------------ <br /> Seepage Pit: Distance to nearest well----_----------------Distance from foundation___-..--------------Distance to nearest lot line..-_---..--._--_ <br /> ❑ Number of pits---- -----------------Lining material-----------------------Size: Diameter--•---•-•--•----- ----Depth-------------•-•-----•------ <br /> Cess -- <br /> Cesspool: ---- <br /> P Distance from nearest well-----------------Distance from foundation-------.-----------.Lining <br /> ❑ Size: Diameter--------------------------------------Depth----------------------- ---- ---------•-----•-----Li Liquid Capacity <br /> �k' <br /> rest well f ------•-gals.PrIvY: Distance from nea -------------------- .------ ---"------.--Distance <br /> from nearest building <br /> ❑ Distance to nearest lot line.-.._-.---."--------------�---__--_ " <br /> Remodeling and/or repairing (describe):----_-. ---___-_------------------------------------------------- <br /> --------------------------------------- --------------- <br /> ----------------------- --------------------------------------------------­------•----•------ <br /> ----------------------- <br /> --------------••------------------------------------------------------------------------------------------------------------------------------------------------------------ •-------------------------------- -I----------- <br /> I hereby ce y t t I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinance , t I and Lules nd'regulati of the San Joaquin Local Health District. <br /> (Signed)------- -- - --- -•------ ------------ - I <br /> B --- -----!.-aG/ ----- ----- rand/ar Contractor) <br /> -- ----- - ---- <br /> L- ii <br /> --- ---- <br /> r ---------- [rile) <br /> (Plot plan, showing sire of lot, locationf f system in relation to IIs, buildings, etc., can be place n b-w" <br /> reverse side), <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------ � E----------------------------------------------------------- <br /> DATE-..---- ----------- ---- ------�•�---------------- <br /> REVIEWED 8Y •-----. . <br /> DATE <br /> SUED------------------!- ----------•- <br /> BUILDING PERMIT IS <br /> --------------------••---------------.._­-....---------• - --------- DATE------------------------------------------------------------------ <br /> � <br /> Alterations and/or recommendations:-.--__..- "-"-.--_.- <br /> -------"------------•--------------------------------------------------------------•----•-----------•-•-----•-----•-------••-- <br /> I <br /> -----------------•------------ -----•-----•----- -------------------------------------- --------••-----•---------------•----------------------•- <br /> ---- ------- ------- --- <br /> - -- - ----••---••---•-----•- <br /> FINAL INSPECTION BY:._- --._ GLS Z <br /> Date----------- - .. •--------------------•- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT T <br /> 130 South American Street 300 West Oak Srreett <br /> 114 Sycamore Street 205 Wast 9th Street <br /> Stockton,California Lodi,California Manteca,California <br /> Tracy,California <br /> ES 9 REVISED 8-54 2M 5-62 ATLAS �` <br />