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r� 1-UK U�FFI E U5E: <br /> --------------- ---------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ...,1r..:.....` <br /> ------------------- ------------------------------------- (Complete in Duplicate) �, <br /> ----.--- This Permit Expires 1 Year From Date Issued x Date Issued ------------------__j <br /> Application is hereby made to the San Joaquin Local Health District for a permit to coretruet,and jnstall-the work herein described. <br /> This application is made in compliance with County Ordinance No. 549.r,-, <br /> - r <br /> JOB ADDRESS AND LOCATION.-. , - f _ ____.•___ r'll____ .r _-----[- <br /> Owner's Name-- x -- t.f-•-•-----•----•-••----•-------------------------•------------- -------------------------------------------- Phone---1-0_4: S_Zr7_6 <br /> Address__.. -`-------- ---- 1----- <br /> Contractor's Name. _ _ __ ------s--- -------------- •-••---•---. _ Phone-------•------------........ <br /> Installation will serve: Residence ❑ Apartment House [] Commercial B'Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -------- Number of bedrooms -------- Number of baths --I----- Lot size -------------------•.---.__...-----..---------_-._...-----.. <br /> Wafer Supply:' Public system ❑ Community system ❑ Private R Depth to Water Table __9.. ft. <br /> Character of soil to a depth of 3 feet: Sand ❑' Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay 0--Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date----------------- ._) 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 200 feet.) i <br /> r ti• Septic Tank: Distance from nearest well-Ja `-_-----Distance from foundation---/P--------- <br /> .._Material <br /> _.---_. � __-_-__-__--�__ C5No. of compartments-------g--------------Size-------3xj ---------Liquid de th_--$1--- Capacity-1290f <br /> Disposal Field: Distance from nearest well--ICO...........Distance from foundation..X4-------------Distance to nearest-lot line--_-----.___----_ <br /> ❑� Number of lines------------1-------- <br /> -------------Length of each line------------------------------Width of trench------9�----__-_--------------- � <br /> Type of filter material----Afi-�--__-_---_Depth of filter material--J� <br /> ---------------- length-------f619 f--___-----_-_-------.-- { <br /> Seepage Pit: Distance to nearest well----_----------------Distance from foundation ..undation-_-----_•--_-__----.Distance to nearest lot line----------- ... <br /> ❑ Number of pits----------------------Lining material__---------------------Size: Diameter---------------------. Depth-----.--.------------- ---.__--_--- ��� <br /> Cesspool: Distance from nearest well-----------------Distance from 4undation------------------- Lining material--.___..---._-..__--------- <br /> ❑ Size: Diameter--------------------------------------Depth------- -------------------------- -----------------Liquid <br /> Capacity---------------...------•---gal <br /> s. <br /> Privy: Distance from nearest well------------------------------------•------------Distance from nearest building------------------------------------------ <br /> 0 Distance to nearest lot line--------- -•-------------------------------- - ••--------------••---- `,: <br /> Rernode' 9.and/ r repairing (descri e�- - ---- ---------'------------- ----- 40—r �� A t <br /> . � ------- <br /> ---------------------------------------------- -------------------------------------------------------------------------------------------------- <br /> ------------- .----- <br /> -------------------------- --------------.----------•------------------ --------------------------- <br /> ----------------------------------------------------•--•--------------------------------------------------------. _J-----------------------------.--.-------------- -------- -------------------------------- -- .... <br /> I hereby certify that I have prep ed this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rule an regulations of the San Joaquin Local Health District. <br /> (Signed)---------------------- --- ---•---- --- --- - -/, � <br /> -------- --------------------------------------------------------------------------•------------Owner and/or Contractor) <br /> By:__----------------------- -- -------- --------------------------------------------------------------------)Title)------------------ ------------ <br /> [Plot plan, showing s lot ocation cm in relafion to wells, buildings, etc., can be placed on reverse side). <br /> FOR D PARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- " <br /> - -------------------------------- --------------------------------------- DATE 2 <br /> REVIEWEDBY----------------------------------------- -- -------------------------------------•---------------------------•--­­-------- DATE. <br /> BUILDING PERMIT ISSUED -..-..---------------------------------- - --------•-. DATE <br /> - --------------------------------- <br /> Alterations and/or recommendations---------------------------------- ---------------•--•---•----------- <br /> --------------------------------•---------------• -------------•------- ---------------------•------------------.....-----------..-...------------..--...----------•----------------•--------------- -•-•--•------------ <br /> FINAL INSPECTION BY:_ 1 - ------------- <br /> IN <br /> -----------IN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> E9-9 REVISED 9.59 F.P.r O.ZM 6.67 <br />