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3 <br /> APPLICATION FOR SANITATION PERMIT Permit No. _-I 4-Yl____ <br /> (Complete in Duplicate) <br /> Date Issued .-_ <br /> Application is hereby made to the San Joaquin Local Health District for a permit fo construct and install the work herein described. <br /> This applicatiori is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION. �s L <br /> Owner's Name. ------------------------------- I------------------------------ ------ --- Phone------------------------------------ <br /> Address------------------------�.0 ------------------------------ <br /> Cantractor's Name ` - --------------------- ------------------------------------------------ ---------------- Phone_4Lfvq------ <br /> Installation will serve: Residence 93­7Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Otherk 10 <br /> ❑ <br /> Number of living units: __/_ Number of bedrooms-_3____'_ . Number of baths ____/ Lot size -----_- 46_x....14d-Q---------------- <br /> e <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table �7 ft. <br /> Character of soil to a depth of 3.fe0:� Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E] Adobe E- Hardpan [❑ ' <br /> Previous Application Made Yes ❑ No,[],-New.Construction:Yes []-No,O--FHA/VA:-Yes' ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: f <br /> (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Ta Distance from nearest Distance from foundation___ ateripl__ - ___ --- _.�----- <br /> + No, of compartments'-- -___----------Size___� ---3-4--------- _� <br /> Liquid depth___.__���___-_-Capacityvr <br /> y� 1 1 � <br /> Des os Field: Distance from nearest well...___________.-.Distance from foundation--------------------Distance to nearest lot line----_---_-----.-- <br /> dumber of lines----=------------------------------Length of each line-----:------------------------Width of french----------------------------------- <br /> Type of filter material------------------ -Depth of filter material-----------------------Total length------------------------------------------ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-----_--_-__----_ I <br /> ❑ Number of pits_____________________Lining material--_. <br /> Size: Diameter-------------'---------Deptn--------------------------------- <br /> r f <br /> Cesspool: Distance from nearest well_________________Distance from foundation`_"________----.Lining material_-____-_____________.___________.____ <br /> ❑ Size: Diameter'_yI---__I-------------_ Li Liquid Capacity <br /> ------------Depth ------------------------------------------------ q - ------------ ---------gals. <br /> Privy: Distance from nearest well___--_--.----- --------------------------------<-Distance from nearest building___--_..----___-____-_--------._________- <br /> t-i .- -T---_..� <br /> ❑ Distance to nearest lot line----------------------------------------------- <br /> 1 <br /> -------------------- --- ' <br /> } <br /> Remodeling and repairing Idescribe]:___- -----__- -• /� - --------- -----•--- ----------- ------------- <br /> -------------------••---•--•---------------------------------------- -----------------------------------------------------------------------------------------------------------------------------------------r------- <br /> --------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------ <br /> t <br /> I hereby rWry that I e prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, S laws, an rues and regulations of f e San Joaquin Local Health District. <br /> t <br /> (Signed)-__-._V - <br /> 9 ) ------ ------------------ ------------------------------------ (Owner and/or Contractor) I <br /> By:. ---••.._�, Rcafion <br /> ------------'-------------------(Title)---- ------------------ --------------- <br /> (Plot plan, showing size of loystemin rel n to wells, buildings, etc., can(be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED SY# <br /> 1 <br /> _' DATE 1 ` � <br /> REVIEWEDBY--------------------------------------------- ----------------------------------------- ------------------------------------- DATE <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------._ DATE <br /> Alterations and/or recommendations:----------------------------------------------------------------------------------------•------------------------------------------------------ <br /> ------------------------------------------------------ --------------------------------------------•- ----------------------------------------------------------------------------------------------------• --'-------------- <br /> - --------------------------------------------------------------------------------------------------------------------- <br /> ------------------- - r <br /> FINAL INSPECTION _R- - - Date-- S�S <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M Revised 1•57 F.P.CO. / <br />