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------------------ ---------­------------ <br /> . <br /> --------- -------- -. _......................................____-_._. A _ICATION FOR SANITATION PERK-nn' Permit No. ..,1 <br /> '_----------------------- --------------- - ........ (Complete in Duplicate) 7/' � <br /> _ This Permit Expires 1 Year From Date Issued�r Date Issued .'-.,1...`.--- - <br /> Application is hereby made to the San Joaquin Local Health District for a permit to corm ructert> mstall the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION .�G ................................................. <br /> Owner's Name---------�!-�`�------ .r� --------------- ------------------------------------------------- Phone.................................... <br /> Addressa-----/8Q!�Ile 40-3----------- -- Z-------------------------------------------------------------------------------------------------- <br /> Contractor's Name_______ <br /> Installation will serve: Residence 20 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: I----- Number of bedrooms I--. Number of baths __/____ Lot size _ aq.-r.A3............................... <br /> Water Supply: Public system (T Community system ❑ Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam (0 Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑� <br /> Previous Application Made: (If yes,date . _ .. __ ) No gJ New Construction: YesK 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__4j_A-t__Distant from foundation-----/_6----.---Material---- ................. <br /> ( No. of compartments------3-----.........._Size.V_ .�.�l k -__Liquid depth._._._.Y-------._.----Capacity./64V..__...._ <br /> Disposal Field: Distance from nearest wellf --f__.._Distance from foundation.-I.G._...........Distance to nearest lot line_ir,___ <br /> Number of lines._._a` ___ ___ _________ Length of each line---- Width of trench. .................. <br /> s <br /> Type of filter matenal .f .- .Depth of filter material _____________Total length..���__'____-_------.---.___--_--- <br /> Seepage Pit: Distance to nearest wel__.______._.__.-.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..................................... <br /> ❑ Size: Diameter.---------- ---- ---- ---- - ---Depth ------------- -------------------.-Liquid Capacity............................gals. <br /> Privy: Distance from nearest well-------------_---------------------------________Distance from nearest building.....................................1-1 . <br /> Distanceto nearest lot line-------------------_--•-------...-------------------------•--------•----------------------••-------•--•--------......................---- <br /> Remodelingand/or repairing (describe) ------•---------------------•----------•-•-----------•-------•-•---•------•---------._......----....-•-----------•----.........•-•-.---•-- <br /> "' <br /> --------------------------------------------------------------------------------------------------- <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 a?d regulations of the--San Joaquin Local Health District. <br /> ••- �== -• -•-fi-t-•----- <br /> _.___.__---._...Owner and/or Contractor(Si <br /> (Sign <br /> ed) ----- <br /> By:------------------------------------------------------------ -------------------------------------------------------- ......(Title)---------------------------- <br /> - --------- <br /> (Plot <br /> ------(Plot 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 /> APPLICATION ACCEPTED BY--- �'z?'' =E` = ----------------------------- ----------------- DATE------ -� - r....----- <br /> REVIEWEDBY-------------------------------------------- --------------------------••-•---••••-----•-----•-•----•-•-------•-•--•-•---•--- DATE---......................................................... <br /> BUILDINGPERMIT ISSUED-------------------------------------------------------------------------------•-................... DATE----------------............................................ <br /> Alterationsand/or recommend'ations:----•---•- •---------------------------••--•-------------------•-----------•------•------•------------•------•-------------------•---•-------••-•--•-------.--- <br /> -------•--•-•-••----------•-----••--------------------•---••---------•-•••---•-----•-••-------•----------------•----------•••••.•--_..---••....._..•••-•---------•--••---•--••••--•-•-•••--_...._......-•••------•----....... <br /> — ------------------•--•---------•--------------•---------••--•-----•-•------------••---•--------•------------•-•-•-----•---•--••-----•-.......------------•••-•--•-•-----•••••-•--••--•------•----•---•••-•--•-•--•-....... <br /> -•-•-•------•...--•- - -- -------------•---------••-•------...----------•-------••-•----------•--------....----------••---•---•-----•••-•-•---•-••---•••••--------------•---•---------•--•--•-••-••-••--••-•--•--••---- <br /> .........................-._.._..._......----- •--...---------_.._..-•------._..._....-------•------------...................................................................................... <br /> ,.s <br /> FINAL INSPECTION Date . ?- � �-•--------•-•-•------•-----...--•---------------- <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 5-61 ATLAS <br />