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27 V . W A�.;-ICATIOK FOR SANITATION PER , Permit No. ---------- ---------• <br /> (Complete in Duplicate) Date Issued / ... <br /> Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein' described. I <br /> This application is made in compliance:with County Ordinance o: 519. <br /> JOB ADDRESS ANLFTION.=-- _•`'il_ =- -.- ---- ------ -------- <br /> Owners Name-------- _ Phone------------------------------------ <br /> Address.......... - ---------- <br /> Contractor's 'Name ----------------------------------------------------- Phone <br /> Installation will serve: -Residence 'Apartment House'❑ Commercial E] Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of bedroom , r <br /> Number of living units: . sj...,Number of baths ___P�___ Lot size _____________________ <br /> Water Supply: Public system Community system El }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: Yes ❑ No 9�<­Nei4 Construction: Yes.0 No �FHANA: Yes ❑ No 99--' <br /> 'TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or`cesspool permitted if public sewer,is available within 200 feet.) <br /> i <br /> ft <br /> Distance from nearest well-----------------Distance:.from foundation-----______________.MafeAal________________________________________-______ i <br /> ti Tank: No. of compartments.------:------- ---- Size--------------•_---------Liquid de.pth--•-----------------=---:Capacity---- --------------•--tuber of lines_________________'- Distance from foundation_____ _.________._Distance to nearest lot line______:..._._____ <br /> p tante from nearest well_-� :Len th of each line--------------- ------------Width of trench-:-----: - ----:----_--:-• <br /> os Fie .,Distance g <br /> Nu <br /> Type of filter material______.______:___ Depth of filter material__/_�_____s________Total length .. �__________________________ <br /> Seepage Distance to nearestwelI______777� ____Distance from f ndation/,$___ ...l ice to nearest.lo�in ___ ___•_______ <br /> RolNumber of pits----f-------------_Lining material:- "--Size: Diameter _-- Depth___-- _-- <br /> Cesspool Distance from nearest well_______ _Distancevfrom'foundation--------------------Lining material________________---.__...._----___._. <br /> ❑ Size: Diameter-------------- y-Depth--------------------------- --- ------------------------Liqui8 Capacity---------------------------..gals. <br /> Privy: Distance from nearest well_________________z___-:_____.-------------_-_4_:Distance`from nearest building___-_.__._-..__.____._.___..____________-_ <br /> ❑ Distance to nearest lot line ---- --•---•-----:----------------------------- <br /> ---------- <br /> Remodeling and repairing (describe)= ? --------- •--•-•--------------------------------------------- <br /> /or . <br /> =---°-•-------•--•----•-----------------------------•-----------•--------•--------------------------= j <br /> QV <br /> -=------------------------------ - <br /> Ihereby certify that I have prepared this application and that fhe work will be done in accordance with San Joaquin County , r. <br /> WI .- <br /> ordinances, State laws, and r s and regu_ _ions of the San Joaquin Local Health District i. <br /> y _____.-_s ^ <br /> (Signed) `- ---------- <br /> i.0 <br /> - (Q�r Contractor) <br /> =-------------------------------------------- ---- =- ==' (Titled - - --------------------------------------- <br /> BY:(Plot plan, showing-size of lot, location system in.r tion to wells,,buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY---- -•- - r•---- ----------------------------•----- -------=----------•------------------- DATE - -- C. - �7-----_------_--------- <br /> REVIEWEDBY = -- • --- .; --------------- = ---------- -----=--- DATE-----------------••-•--------_--= --• ----•- <br /> BUILDING PERMIT ISSUED - ---------- DATE------------------------------- -------- <br /> Alterations and/or recommendations: ---------- -----=------------------------ --------------------------••----- ------------. ...................------. <br /> -------------•------_----- - ---------•---------•------•------------•-------------------•--__- =------•-----=--- --------•--------------------------------------•--------------------=------- <br /> ---------- <br /> -------- ----------X - D>_3� = 5� ........ -= = <br /> -- � ----- + 171:Hl � ---------•-----------------------------•-•-••------•------------------•-------------=------------------------- <br /> FINAL INSPECTIO 'BY---- - ------------A- - Date � ---=-------------------------------- <br /> SAN JOAQ,0IN LOCAL HEALTH;DISTRICT <br /> 130 Soufh American Street 300 West Oak Street 132 Sycdmor6 Street 814 North "C" Street <br /> Stockton, California Lodi, California. Manteca, California Tracy, California <br /> ES-4-2M Revised 1.57 F-RCO. <br />