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FOR FFICE SE: <br /> --------------------- ------ APPLICATION FOR SANITATION PERMIT Permit No. ... ...1._. <br /> ------ -- --------------- -- ------------- ------------- (Complete in Duplicate) <br /> Dote issued <br /> ------------------- This Permit Ex 'ires 1 Year From Date Issued .......�.r1�./.. <br /> Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. , <br /> JOB ADDRESS AND LC? ATION------�- -'�`='-"--=c--��---..-----..C�-r::K- - -G�x�--�-----1-�=-• --- '� •....-`--- ••----•-----......----•--••--- <br /> Owner's Name--------------- . -�---------- ---------- - ---------------- --------------------- Phone------------------------------------ <br /> Address > <br /> ` `---- r <br /> .....-•----•----••----------•----------- <br /> Contractor's Name----------------- r c am .-----------� -------- s Phone.................................. <br /> Installation will serve: Residence 8--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ../--. Number of bedrooms _- -. Number of baths .__.t- Lot size --------------- <br /> Water Supply Public system [3-"-Community system ❑ Private ❑ Depth To Water Table Z-__JTt. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [}—Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date--__...............)To [ New Construction: Yes ❑ No E3--FHA/VA: Yes ❑ No B- <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 well-----`mo o--Distance from foundation....e_1.a........Material. •�:e__-r <br /> No. of compartments-------..L-----------Size----- yt'_ - --d"_--Liquid depth----------`X--------------Capacity............ <br /> Disposal Field: Distance from nearest well----:�_ "--Distance from foundation.....3.4........Distance to nearest lot line------1-�.•� <br /> [ Number of lines..............."rr--------Length of each line---------------l-a--------Width of french.-.-_---_.--. ---------------- <br /> Type <br /> -------------- <br /> T e of filter material.. C Depth of filter material--_- _. _. --...--Total length............... . <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 /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---------------...................... <br /> ❑ Size; Diameter------------- -------- -------------Depth-----------------------------------------------------Liquid Capacity-----......................gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--_--------------_------------.--..------. <br /> ❑ D,istance to nearest lot line---------------------- •------------------------------................ --------------------------------------•-------------------------- <br /> Remodeling and/or repairing describe}: ; - ss -. -- `` ........ ..Z.:. ""=='---- -----•---------------- <br /> --•-------------- •---------- --- ------•-----•-----------------------------•----------------------•--------•-.................--------I——------ ---- <br /> ------ ­­---­----------------------­---------------I-----------------------------------------------------------------------•---•--------•--------••---•--------•---------------....----------•--------------------- <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, S +laws, and �/ruliesaregulations of the San Joaquin Local Health District. A <br /> Si reed "� ---------- Owner end or Contrac#or{ g ) ------------------- ----- -- - ---( / ] <br /> BY:------------------------------- --------- --------------------- --•-------------------------------------------------(Title)-------------------------------------------- ------------------ <br /> (Plot plan, showing size of (o of system.in relation to wells, buildings, etc., can be placed on reverse side). <br /> F DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED 8Y--------------A <br /> _.. r DATE f <br /> REVIEWEDBY--------------------------------------- - ----------------------------------------------------• DATE------•---•--• ----....------------------------------------ <br /> BUILDINGPERMIT ISSUED--------------------------------------------------------------–•--------------------------•- ...... DATE-------------------------------- ---------------------------- <br /> Alterationsand/or recommendations:--------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------- <br /> -----•---------------•---•--......------••-------•--•-...------------------------------...---------------------------....._..-----._..-..---------•------"-"------•-•-------------------------------------------------••--- <br /> ------------------•-----------------------------------•-------------------------------...--------- ------ -----------••---------------.-.---------------------------------------------------------------------------------- <br /> ------------------------- <br /> FINAL INSPECTION BY: `----_ ----------- <br /> Date. ` �11 <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 6.59 2M 5-62 ATLAS <br /> 1 <br />