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FOR OFFICE USE: <br /> ------------------- ------------------------------------ <br /> . APPLICATION FOR SANITATION PERMIT Permit No. .y.... . <br /> -------------- -------------------- ------ (Complete in Duplicate) y� <br /> -------------- This Permit Expires i Year From Date Issues{ 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_ .r? �_.� lJ---------- ----- - --- --------- <br /> Owner's Name... --------------------- Phone------------------------------------ <br /> Address............ <br /> ----------•---••-Address.--------••, �. !'� ' 0 <br /> --.............................. ---- .................................. <br /> Contractor's Name -•----------------•-------•------------------ --- _------------_--------- Phone................................... <br /> Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ___I___ Number of bedrooms --- Number of baths _1___ Lot size ---____________________________________ <br /> Water Supply: Public system ❑ Community system ❑ Private JR Depth To Water Table -Iq- ft_ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ® Clay ❑ Adobe❑ Hardpan.® <br /> Previous Application Made: (If yes,clate--------------------) No ® New Construction: Yes 0 No ❑ FHA/VA: Yes ❑ No ❑ � <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---J"d_------Distance from foundation----/d_---------Material______r�1`✓ /ir _______________•----- <br /> IR No. of compartments------A----------------- �3r _ __s�.___Liquid depth------Y_--------------Capacity.t,i�"--___-._ <br /> Disposal Field: Distance from nearest well__ot-r__9-------.Distance from foundation_ d_____________Distance to nearest lot line-.�`0........ <br /> ® Number of lines---e---------------n-------------Length of each <br /> � - line...�X _' . Width of trench..- - _--___--_-_-_-_-_-_-_-_-_-_._-_ <br /> . <br /> Type of filtermDepth of filter material, __y_ Total len th.--ft_'___________ <br /> - <br /> Seepage Pit: Distance to nearest well--407_-_____-_-Distance from oundation...,1__!)_�.__.__.Distance to nearest lot line_��-._.._._. <br /> INNumber of pits___._____________Lining material____-_Size: Diameter_---. _„ -��--------Depth-As ..................... <br /> i <br /> Cesspool: Distance from nearest well_________________Distance from foundation..-----------------.Lining material-----------------------------------.- <br /> [❑ Size: Diameter---• ------Depth--------------------- ------ ----------------------Liquid Capacity-----------•------------_-gals. <br /> Privy: Distance from nearest well-----------------------------------------_______Distance from nearest building-----------..---_________._-__-__-_____--- <br /> ❑ Distance to nearest lot line <br /> Remodeling and/or repairing (describe):-------------------------------------------------------- •--------------------------•- <br /> -----------­--------- ----------------------------------------------------•------- -------------------- -•----------------------------------------------------------- ---- <br /> with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)_-_-------------- - ---• ------ --- ---------------- ---------------------------------------------------------------------------(Owner and/or Contractor) h <br /> By:--------------•------ -----------------------•---------- --------------------------•----------------------------------•------------(Title)-----------------•------------------ -----_------ -------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> 42 FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY. t <br /> -----------•-------------••------------ DATE__ --- 6- <br /> REVIEWEDBY-----------------------------------------------------------------------•- ---------••--------------------------------------- DATE <br /> BUILDINGPERMIT ISSUED------------------------ -•---------------------•----------------------------- -------------•-----•-- DATE-------------------------------------------------- <br /> Alterations and/or recommend'ations:------------------------------------------------------ <br /> -------------------------- <br /> - --------- <br /> ------- <br /> -------------------------- • <br /> ------- ---------- <br /> ............. ----...._ V------------------------------------------------------ <br /> -- -- ------------------ .------. ----------------------- -_-------------------------------------------------------------------------••------- <br /> -\---------------------------------------------------- <br /> FINAL INSPECTION BY:.......................... --------------- Date.- <br /> : <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 2M 5-62 ATLAS <br />