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FOR OFFICE USE: <br /> --------------------------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. .. �:2e _ <br /> ------•-- ---------- --------------------------- (Complete in Duplicate) , ._ <br /> --------------- This Permit Expires 1 Year From Date Issued Data Issued ._ ._______ ..__l <br /> 0_5 <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descrbe�. <br /> his application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATIONo W - -------- � w ----9 ------------- --- `' ----------------- ---- <br /> Owner's Name - <br /> �g �-------- -------- Phone..........•-••------- <br /> Address ....---•-,}...... ...................--............................................................... <br /> Contractor's Name.,,. C YEctlu (l 44 ........... -••---------•----------- Phone----------------------------------- <br /> Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: - _._-. Number of bedrooms 3___. Number of baths Y..... Lot size ___ __--------------___ <br /> Water Supply: Public system ❑ Community system ❑ Private, ] Depth To Water Table . ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy loam M Clay Loam ❑ Clay ❑ Adobe❑ Hardpan [ Q <br /> Previous Application Made: (If yes,date.-------------------) No ® New Construction: Yes ] No ❑ FHA/VA: Yes ❑ No F .�J% <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_________________Distance from foundation-------------------Material___--...__-.-.-----_ ............. h <br /> ❑ No. of compartments--------------------------Size--------------------------- ---Liquid depth----------------.--------.Capacity--.._..-.-----...__._. <br /> Dis osal Field: Distance from nearest well--S-b--------Distance from foundation---Z ..........Distance to nearest lot line_______. <br /> Number of lines----1we <br /> .........� ___-. _Length of each line______,[�_-'.-.-_-_-.Width of trench....... �!_________________ <br /> Type of filter maf - __��_Depth of filter material------ _�!____-_.Total length_-/. "b........•................. <br /> Seepage Pit: Distance to nearesgr <br /> Seepage 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. ..........................galsX <br /> Privy: Distance from nearest well--------------------------------------- _.____Distance from nearest building.._..---------------._..._________.___- <br /> ❑ Distance to nearest lot line--------------------------------------------------------------------------------------•-----------------•---------•------------•-----•-------- <br /> Remodelingand/or repairing (describe)----------------------------------------------------------------------------------------------------------------.......................................... <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, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed) w1r " i ?a____- -' -_--- -- <br /> (Owner and/or Contractor] <br /> By:-------- -------------------- Title <br /> (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> --- DATE /SO <br /> APPLICATION ACCEPTED $Y - <br /> REVIEWEDBY--------------------------------------------------- -------------------------------------------------------------------------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED----------------------------------------•----------•-------------------------------------------------- DATE--- --------------------------------------------------------- <br /> Alterations and/or recommendations:---------------------------------------------------------------------------------.--------------------------------------------------------------------••------ <br /> ----------------------------------------------------•------•---._...----------------------------------------------------------------------------------------------------------------------------------•---•-••-------•-----•-- <br /> ...................•--------- ------------------------------------------- ---------•-- ----------------- --------------------------------------------------------------------•------------------------------------------- <br /> ---------------------------------- -------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------- <br /> // <br /> FINAL INSPECTION BY:- Date. 7_�� ------•- ---------- --•----- ------ ----------------------------- <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 5-59 zm 5-62 ATLAS <br />