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FOR OFF E U E: 1 <br /> 3d <br /> 9 <br /> ----------- - -- APPLICATION FOR SANITATION PERMIT Permit No. ..,. <br /> ----4(.�-g-- - --(� --^-` [Complete in Duplicate) <br /> f Date Issued 3 <br /> _................. ;. This Permit Expires 1 Year From Date Issued <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. <br /> JOB ADDRESS AND LOCATION---- ..... '-*1 s------- <br /> Owner's Name: fir u�at-orf.... Phone <br /> Address_ ti ----- -•--••-----------------......................................----•••-•--- <br /> Contractor's Name.......... <br /> S 7--- Phone---------------------------------- <br /> --------------------------------------..-_. <br /> Installation will serve: Residence [!'" Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ----!_ Number of bedrooms __2 - Number of baths _/____ Lot size .- -----------------•------------------ <br /> Water Supply: Public system ❑ Co`mmunity system ❑ Private Depth To Water Table k_q. ft. I <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0- Hardpan ❑ <br /> i <br /> Previous Application Made: (If yes,date--------- ----------) No Qa�'_New Construction: Yes E No ❑ FHA/VA: Yes 0 No �r <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet. i <br /> Septic TaI -=nk: Distance from nearest wellr�__.____Distance from foundation-1 ... Material_____ .-n_______________ ____________• <br /> [ � No. of compartments-.------ -------- ----Size---3.XxSV- <br /> X -----<---Liquid depth 9 -------- <br /> Dispo4 Field: Distance from nearest well__y_6.......Distance from foundation.---t'----___. Distance to nearest lot line-.`..'_-.'.-____. <br /> Type filter matenal �_�=_ _.-______.De Depth of filter Width of trench :`:.................... <br /> f g . <br /> yp p / ----------Total length -------- ------- ---------- <br /> Seepage Pit: Distance to nearest well__04-..._..____Distanc om foundationl�!...__••___..Distance to nearest lot iine..+X......... <br /> i ___---_Lining material.___ _lff=`i.-____.Size: Diameter___` Depth <br /> - -___._____- _--= r-`------------------ <br /> • Number of pits------`_------- <br /> Cesspool: Distance from nearest well_________________Distance from foundation-------------------.Lining material..-._______________------_____--_-_-_ <br /> ❑ Size: Diameter----i---------=---------------------Depth------------------------------ ------Liquid Capacity----------------------------gals. <br /> t <br /> Privy: Distance from nearest well---------- --------------------------- --- -__Distance from nearest building-------------------------...------------- I <br /> ClDistance to nearest lot line---------- ------------------------------------------------------------ --•------•---------------------------- --------------------------- <br /> 1 <br /> 2 <br /> Remodeling and/or repairing (describe---------------------------------- --- -------------•-•--------••---- <br /> ----------•-----------•-•-------------------•---------- ------------------­-- <br /> ­------------- <br /> •------- -- <br /> ------•-------------------------------•--------.-- <br /> ---------------•--------------------•-- ---•--•----------------------------•----------•- <br /> ------•-- = ----------- ------ -- - - •-• ----------------------------------------------------------------------------------------------•----_------------------ -------------- <br /> I hereby certify that 1 have prel'ared this applicatia and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations f the an Joe in Local Health District. <br /> i ---____---_....[Owner and/or Coritractorl <br /> (Signed)_ -- -- - --------- ----- ---------• -------------------------------------- <br /> F t <br /> -----------------------------------------(lTitlB------------------------------------------ .... . . ------ <br /> 1 <br /> [Plot plan, showing size of lot, lacatiot o srelation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- mak ; ' ----------------- -------------------------------- ------ DATE--- ---------------------- <br /> REVIEWED BY------------------------------------ ' ------------------------------------ <br /> ........_..._. DATE-------------------------- ------------------------------ <br /> BUILDINGPERMIT ISSUED-------------------------------------------- --------------_ -------------------------------------- DATE..-•------_---- l <br /> 4 a- 3--------� - ��"� �► -- <br /> ----------------------- <br /> Alterations and/or recommendations:_____ -" -' <br /> ---------------•------•---------------------------------------------------------------------------------- <br /> ---------------------------- --------------- ------------------ --------------------------- -------------------------------------_------------------------------------------------------------------------------------- <br /> ------------ ----•----- ------------------ -------------- <br /> ------------- ----------------•----- ---- ------------------_. -----•-- ���J <br /> FINAL INSPECTION BY_.!� - --- Date------ - - <br /> 'SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ' a 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 ZM 5-62 ATLAS <br />