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iM <br /> APPLICATION FOR SANITATION PERMIT Permit-wo- <br /> i (Complete in Duplicate) <br /> Date Issued <br /> �I <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 /> i <br /> JOB ADDRESS AND LOCATION / ---------g_i_7f------------•-•-------------------------------------�--•----- <br /> Owner s Name---•--------------- --------------------- --------•-•----------------------•----------------------------------- ---- Phone / <br /> Address------------------- -------1S1-------4d.e`p O1------5 ----------e -i- &------------------------------------- <br /> ---- <br /> --- <br /> ------------------------.----------- <br /> Contractor's Name �� ��Gla - -- Phone <br /> Installation will serve: Residence [A Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __- Number of bedrooms _Z-- Number of baths ________ Lot size ------�-a-- _?C___/ ------_____________ <br /> WateI`r Supply: Public system Community system ❑ Private ❑ Depth to Water Table _aS-__Pft. <br /> Charbcter of soil to a depth of 3 feet: Sand Gravel Sand Loam Clay Loam Clay Adobe Hardpan <br /> � p ❑ ❑ Y ❑ Y ❑ Y ❑ I$l ❑ <br /> Previus Application Made: Yes ❑ No 10 New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> I (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------.Material___-_________-____________-_:____________-- <br /> No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- <br /> IpasaF- Id: Distance from nearest w f1_____________._Distance from foundation--------------------Distance to nearest lot line----------------- <br /> �P; <br /> �.j Number of lines------------ -------------------Length of each line---------&L2_------------Width of trench----------------_----------------- <br /> -IfI 1 Type of filter material-------------------------Depth of filter material-----------------------Total length.......----•------------------------------ <br /> See <br /> --•-____-- ------------__-•-- <br /> IN - r <br /> Seelage Pit: Distance to nearest well----Alaji/�'---Distanc,�from foundation____./Q_____....Dista e to nearest lot line_�f0__e---- <br /> Number of pits--_----I------------Lining material___ C_ ------- Diameter____,F,�----------Dept h------.. .5----------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---------.___-______________________- <br /> 1 Size: Diameter---------------------- ---------------De th----------------------------------------------------Liquid Capacity gals. <br /> Privy Distance from nearest well-------_------------------------------------------Distance from nearest building_____--_______--______________-____-_-___ 51. <br /> IDistance to nearest lot line-------------------------------------------------•----------------------•-------------------------------------------------------------------- <br /> Reml�deli�anclorpairin . describe}----------- ------------------------------------ G / <br /> ---- -- --- --- --------------- <br /> 1� i -- <br /> Ip <br /> i <br /> CI hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State s, and rules an lations of the San Joaquin Local Health District. <br /> (Sign led)- ------- --- ------------------------------------------------- (Owner and/or-Contractor) <br /> ,Y:--;�o <br /> � - - ----- ----- ------------------------------------------------------------------------(Title)--(Plotplwing size of lot, location f system in relation to wells, buildings, etc., can be placed on reverse side). <br /> y <br /> FOR DEPARTMENT USE ONLY <br /> h s\> <br /> APPLICATION ACCEPTED BY­,.,-- - ------ - ---------------------•------------------------------ -------•-•- ••---• DAT --s --------------------------------------- ---------- <br /> - <br /> REVIEWEDBY--------•------------------------- ------------------------------------------------------------------------------- DATE-Vi ------•---------------_--...__----••--•----------- I <br /> i3UILQING PERMIT ISSUED -------------------------------•------------------------ DATE fn <br /> ! aerat1io`nf�s and/or <br /> n /or r--e-c--o- <br /> dat __ --------------------------------- _-___r __ _____ <br /> A , io <br /> -;-n ' <br /> - -- <br /> . ,• +-------------------------------------------------------- <br /> -•-••------------------------------------------------ <br /> .{ <br /> -------- - l <br /> ------------ <br /> -------------------------•-•----------•------•-•--------------------------------------- ----------------------------- --------------------------------------- ----- • ----- -- ------- ------ <br /> -------------------------------------------•-------•------------------------------------------------------------------------------------------------------•---------------------------------------- <br /> �4j� <br /> FINAL INSPECTION BY:---------�-------------------- - ----- - Date----q---�.----------- - 1 ------------ ------------------ - - -------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES'`9-2M Revisea 1-57 F-P.CO. <br /> .11 __ _ — <br />