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7 ' <br /> APPLICATION FOR SANITATION PERMIT Permit No. ..__._..... <br /> .......................... ----- (Complete in Duplicate) ' <br /> This Permit Expires ] Year From Date Issued I Date Issued ------------1-6--- <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 Ordinanc No. 549. <br /> At <br /> JOB ADDRESS AND LOCATION__..._-. 1? 1_.__. ._. _.._ `-'_ <br /> Owner's Name------ 4q....... � .----- -.---•-• '!1 ._.. <br /> Address. - g ... .. -------------•--------------------------------------------------•--------- <br /> 7- <br /> Contractor's Name_ �- .. C�--. .. ---- Phone_.__��.�'�_/ <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: --- Number of bedrooms ----..._ Number of baths ........ 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 ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ 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-----------------Distance from foundation------------........Material----------------...-. h <br /> ❑ No. of compartments_________________ _______Size----------------•--------------_Liquid depth..........................Capacity....................... <br /> Disposal field: Distance from nearest well-_....... Distance from foundation_._ -----Distance to nearest lot l�e...$5-___-_ <br /> [ Number of lines______________f. _ _______Length of each line._..._.%G__t�-f___.Width of trench------z.................________ <br /> Type of filter material__ ___._-Depth of filter materia(l)-if-..........Total length___- _Q O'-_________-_________ -- <br /> Seepage Pit: Distance to nearest well......................Distance 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------------------------------- ..,jF0 <br /> El Size: Diameter................. ...De th------------------- ---_-Li uid Capacity............................gals <br /> Privy: Distance from nearest well-------------------_...........................Distance from nearest building.......................................... <br /> ❑ Distance to nearest lot line..---------...-•----...._....---"-'-�-----•......................... ---------------------•-------•-•----- <br /> Remodeling4 <br /> and/or repairing describe :---- r !✓4?---- .- ___ _- ____- ----___•-__-___................__... <br /> ..................-.................. ----•-••------..__..-----._._...._--...._..._._..._......_..._...._...._---......----------••---------•-•------------------•-•----_--------•---•-----•••----••-__------ .. - •--_----- <br /> I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, St a laws, and rules and regulations f the S Joa uin Local Health District. <br /> 5i ned �.ot, tiocation <br /> -vV ------. __Owner and/or Contractor <br /> .. - <br /> ------------ <br /> By:--------------------•------ -_----------------- ---------- ------ <br /> ..........-----•--•------------(Title)-------------------------------- - ----- -- <br /> (Plot plan, showing size of of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY... .� _z z r1 � -------------- --------------------------•--••-------- DATE -•-��----- - ------ <br /> ---- <br /> -------------------- <br /> REVIEWEDBY.............................................................................................................................. DATE----••--------•--....--------•----•--•----------------- <br /> BUILDINGPERMIT ISSUED......................................---•....................--..................................... DA-TE------_------------••--------••----------_---.----•----.--__ <br /> Alterations and/or recommendations:---------------------------------------------------------------•-------------------------•------------••---- -•-----••-•-••---•----•--------------•- <br /> FINAL INSPECTION BY e _�;! _1: ._ _f -•-•--------------- Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E-Haxelton Ava, 300 West Oak Street 124 Sycamore Street 205 West 9th Street < <br /> i <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> JL <br /> CS 9 REVISED 8-59 inn 3-'63p- <br />