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F <br /> vpata,o 1� <br /> -------�__ -------- - APPLICATION FOR SANITATION PERMIT Permit No. <br /> --------------------------------------------------------- <br /> (Complete in Duplicate) <br /> ------- ----------------------- This Permit Expires I Year From Date Issued Date Issued ....... <br /> ---------- <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 o. 549. <br /> JOB ADDRESS AND LOCATION- W ..................................................................................... <br /> . ......................... <br /> Owner's Name....._._;tkud... .................----_----------­ -------------------------------------------- Phone------------------------------------ <br /> Address-------- ----------------------------------------------------------­"-------------------------------------------- ---------------------------- <br /> Phone................................- <br /> --------------- <br /> Contractor's Name-------- . - <br /> Installation will serve: Residence 18 Apartment House F1 Commercial Trailer Court rl Motel 0 Other 0 <br /> Number of living units: _/... Number of bedrooms _f_ Number of baths ........ Lot size <br /> Water Supply: Public system Ro'Community system E] Private E] Depth to Water Table ZAP ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel [] Sandy Loam [] Clay Loam E] Clay [] Adobe W"A'ardpan 0 <br /> Previous Application Made: (If yes,date-----------:-------.) No P�r�New Construction: Yes [] No EY'FHA/VA: Yes E] No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Swtic Tank., Distance from nearest well---------------Distance from foundation....................Material------------------------------------------------- <br /> No. of compartments------------------ -------Size................................Liquid depth................ ---------Capacity--_------------------ <br /> Dispolsal,ield: Distance from nearest well.-.---—------Distance from foundation...AK7.........Distance to nearest lot linebO....... <br /> Number of lines--------- Length of each line-ZAKI----------------Width of trench.-.2--------------------------- <br /> --------Total length...le-tV.*........................ <br /> Type of filter material Depth of filter material....Ar <br /> rSee it: Distance to nearest well---------------------Distance from foundation....................Distance to nearest lot line................ <br /> iw Number of pits----------------------Lining materia----------------------- ize: ameter.............. --------Depth................................. <br /> Cesspool: Distance from nearest well........ --------D I istance from foundation.-------------------Lining material------------......................... <br /> 1771 Size: Diameter------------------------------ -------Depth----------------------------------------------------Liquid Capacity............................gals. <br /> Privy: Distance from nearest well---------- -------------------------------------Distance from nearest building------------------------------------------ <br /> 171 Distance to nearest lot line--------- ----------- .......................I---------------------------------------------------------------------- <br /> ......................................... <br /> ............................. <br /> Remodeling and/or repairing (describe):----_----------- <br /> .........................................-----I..................................---------------------------------------------------if...........................................----------------------------------------- <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, qnd rules and regulations of the San Joaquin Local Health District. <br /> -----------------------------------------------------------(ow"111=1111111:11ftT Contractor) <br /> (Signed)--------------01��_ ------- <br /> By:---------------------------------------------------------------a��14------------ <br /> - ----- --------------------------------(rifle)----eo-�Oef------t---------------- -- ---- --------- <br /> (Plot plan, showing size of lot, location of syslvKin relafion to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY--------------------- -- - -------- ---- ------------------------------------------------------ DATE................. --------------------------- <br /> REVIEWEDBY------------------------------------------------- ------------ ------------------------------------------ DATE........ ........... .................. <br /> BUILDINGPERMIT ISSUED_--_---------------------_- -------------------­--------....................................... DATE------------------------------------------------------------- <br /> Alterationsand/or recommendations:------------------------- ----------------------------_..................................................................................................... <br /> ----------------------------------------------------------------------------------------------------------------------------------------.................................................................................... <br /> --------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------- -------------------------------------------------------------------------------------------------................................................................................... <br /> -------------------------I-------------------------------------------------------------------------------------------------------------------............. ----------------------------------------------------------------- <br /> FINAL INSPECTION BY:----C_ _&&�------------------------------------- Date---- ............................................. <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 8-59 F.P.CO.2M 6-60 <br />