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FOR OFFICE USE: ~ <br />-- <br /> Permit No. al., <br /> `j-,S� �----- <br /> --- <br /> � �, APPLICATION FOR SANITATION PERMIT <br /> ------------------------ _----------- ------------- (Complete in Duplicate) Date Issued -•-.--I <br /> This Permit Expires 1 Year From Date Issued s <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 A L ATION- _--. - .- y <br /> � ''`�---fpm- jn�-�-- ---•----- _ 7 a <br /> Owner's Name _ <br /> ------------ Phone.../....•-_•-----•••-�....� <br /> -� ,,`� L <br /> Address__ `•1'x' �' f -o--- = Phone------_---_--------------- <br /> .Contractors <br /> .__.Contractors Name------ _-__ <br /> `3 <br /> Installation will'serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> _- Number of bedrooms �6d x �----------------- -•--•--... i <br /> Number of living units: _ -___ Number of baths c�.. Lot size ......................9_--- <br /> Water Supply: Public system ❑ Community system ❑ Private'�pth To Water Table .�(o ft. <br /> Sand Gravel S dy Loam ❑ Clay Loam ❑ Clay Adabe Herd <br /> Character of soil to a depth of 3 feet ❑ ❑ <br /> wu <br /> Previous Application Made: (If yes,date--------------------) No New Construction: Yes [7No ❑ FHA/VA: Yes ff No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 2QQ feet.) <br /> g'..'.:---- - <br /> Septic nk: Distance from nearest well_-7 _----Distance from foundation-/.(U_-----------Material----- ------------ _2 <br /> No. of compartments------•2-----------------Size-------3---)S-VX-g-• ---Liquid depth___!- -----------------Ca�aclty.-..�----Q (.. <br /> s F <br />` Disposal Field: Distance from nearest Welk---7+�`.--._.-Distance from foundation------_____-.Distance to nearest t line.. ........... <br /> Number of lines..--___-_..� Length of each line-_7g------ -- -------Width of trench.-...---�'.�'__..-.-....-__...___ <br /> ofr- --__--Depth of filter material. <br /> - <br /> ---r�--- Total length------r V-�....--------•-- - - <br /> Type of filter material._.-/__----. - Dep j j <br /> Seepage Pit: Distance to nearest well/42P Distant om foundation_L. r-_....--.Distance to nearest lot line.5-..__:_..... <br /> Number of pits------� 9 '3r ------.Depth--- �------ ------ A <br /> -_--._-Linin materia___- . GIC.-.-__-size: Diameter._. -----.- <br /> i„ <br /> Cesspool: Distance from nearest well---_...-----__._Distance from foundation--------------------Lining material__-...--.-,-_.-----..._-----.._.__... <br /> ❑ Size: Diameter--------------------------------- ----Depf k---------------------- •----- -------- -------_----Liquid Capacity gals <br /> . <br /> rrl <br /> f .---Distance from nearest building <br />. Privy: Distance from nearest well--------- ------------------------- ------- ---------• ------•-----••----.-...----••------------ <br /> ❑ Distance to nearest lot line------------------------- -------------------------------------- <br /> I Remodeling and/or repairing (describe):----------------------------- ----•-----••---••----------•------------- <br /> --------------------------------------- <br /> -----•-------•----•-----------•-------•--------------•----•--•--•-------- ---------------- <br /> I hereby certify that I have prepared this applicafion and that the work will be done in accordance with San Joaquin County <br /> i ordinances, State laws, and rules and r gul ions f the San Joaquin Local Health District. <br /> 'R <br /> (Signed)... -------------------(Owner and/or Contractor) <br /> ----- -------- <br /> By:--------------_- - - <br /> - --- ---- - ---- <br /> - - (Title)--------------------------------------------- ---------------- <br /> (Plot plan, showing size o f syste in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------A -------- --------- ------------- DATE----- ----------------V---- <br /> ti ••-- -•----------- DATE-------------- -------•----------------------------------- <br /> REVIEWED BY - ------------------------- ----------- DA' <br /> BUILDING PERMIT ISSUED----•---------------•----------------------------�------- <br /> Alterations-and orecommendations:----- F_Z�-came <br /> -------------- - -- <br /> I <br /> --------- <br /> -----------------------­...-•------- ......... <br /> ----------------- Date----- <br /> FINAL INSPECTION BY:---�,,--- �-.. -- ------------------------------ --------- --------- <br /> SAN <br /> -•- --------•- ---------------•------------•-------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Stmt 205 West 9th Street <br /> Stockton,Californla Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 6-59 2M 5-62 ATLAS f <br /> t / <br />