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FOR OFFICE USE: All <br /> -------------------------------------------------------- /r <br /> -------------------- -- --------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. ..., __/:_1s <br /> --------------I-- ---- ---------------------------------- (Complete in Duplicate) <br /> __.-. -- This Permit Expires 1 Year From Date Issued Data Issued __...___1 ..� <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. 1-73 --13.3Lf <br /> b - i 11, E <br /> JOB ADDRESS AND LOC ION at j -- d-------- - --?/ <br /> Owner's Na - ---------•---- Phone-------------------__- <br /> Address______f / /- <br /> Contractor's Name--------------------- a �------P-4te— -----S47-1--------------- ----------------------------------• Phone----------------------------------- <br /> Installation will serve: Residencepartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _1____ Number of bedrooms__ Number of baths ---- Lot size ___-__�0-_ ---------------------- <br /> Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table --7-/1 <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Cl a ❑ Adobe Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) Noew Construction: Yes o ❑ FHA/VA: Yes ❑ No ®.-� <br /> w-- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic +ank or cesspool permitted if public sewer is available within 200 feet.) <br /> I <br /> Septic Tank: Distance from nearest well------- ------Distance from foundation___/a--------Material---•c --------------- <br /> No. of compartments______ __._ <br /> ------------- ---Liquid delath__..J_�1al-----------Capacity,9V.0_... -------- <br /> Disposal Field: Distance from nearest well_,,... --__Distance from foundation-__/0__/-.-.--Distance to nearest lot ______ <br /> 1JI / Number of lines________------_-------------Length of each line----- ------------Width of trench---Q_5K 1_________-_________ <br /> Type of filter materialDepth of filter material---j&Y-----------Total length----/5-V......_______________________ <br /> Seepage • : Distance to nearest well --_____-_Distance from foundation --------Dist to nearest lot line_- ------- <br /> Number of pits___'-__l________Lining mate rial_Y_C?C_Z_.__-Size: Diameter___'__...........Depth---Q�____________________ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------.______--____.______.____..•... � <br /> ❑ Size: Diameter---------------------------- ------Depth--------------------- ------------------------- ---Liquid Capacity------------------------....gals. <br /> Privy: Distance from nearest well______f---------------------------------------Distance from nearest building------------------------------------------ <br /> F1Distance to nearest lot line------------------------------- -------------------------------------------------••-------------------------------------•------------------- <br /> Remodeling and/or repairing (describe):------ ------------�1----J . I---- -•- <br /> --------------------------------------- <br /> --------------•------------------------------------...-.------------------------------------ •---------------------•• ----------------------••-------------- <br /> ------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -------- <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 and re ations of the San J aquin Local Health District. <br /> _- ---- -----------------------------(Owner and/or Contractor) <br /> By:---------------- �-f� --- {Title) �����- 'r <br /> (Plot plan, showin a of lof, location of system in relation t�-vfekis, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----C--•----- ------------------------- ---------------------------------------- DATE----�_ml_ke_--(P-t------------ ----------------- <br /> REVIEWEDBY----- ----------------------------------------•--------------------------------------------•----•--------------- ----------- DATE------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED---------------- -------•------------------------------------- ----------=---------- ------ DATE------- ----------------------------------------------------- <br /> Alterations and/or recommendations:__._ic. Z__.._Cn.i---------- ---------t_tr4- i^h.ta ------------- `(-•--��14147-&.--- <br /> ---------- <br /> ut .(� :} 0 : 5--------------------------------------------------------------------------------------------------------------------------- <br /> FINAL INSPECTION BY:----6-- 4i� - =--- +----------------------------- Date._.. `-`z r ----------------- ------------------------- <br /> SAN JOAQUIN 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 /> ES-9 REVISED B•59 F.PX0.]M 6.60 <br />