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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued <br /> This Permit Expires 1 Year From Date Issued ----------- <br /> Application is hereby made to the San`Joaquin Local Health Disfrictior a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No.519. <br /> JOB ADDRESS AND LOCATION-------- ------ - ------ ---------------------- ...........�­­---------------------------------- <br /> Owner's Name---------------Ca---c-------- ------ ------- ----- - - ------------------------- -- ------------------------------ <br /> � <br /> Address------------------------- <br /> 6P <br /> Contractor's Name------------- -(5;--------------- <br /> -- ------------- --------- --------------------------------- Phone4 P7 <br /> Installation will serve: Residence Ug-'Apartment House F I <br /> I Commercial'E] Trailer Court El Motel E] Other E] <br /> Number of living units: j--- Number of bedrooms Number of baths _V_ Lot size ---*_41- .�- ------------------------------- <br /> Water Supply: Public system E] Community system F] Private 2KDepfh to'Wafer Table X1 t. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel F Sandy Loam E]' Clay Loam El Clay 0 Adobe 011Hardpan 0 <br /> Previous Application Made: Yes [] No PKNew Construction: .Yes E] No Er"FHA/VA: Yes E] No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> 4 ji k: Distance from nearest .well_________________Distance from foundation_-_-___.__-._------Material--__-____--____.-_____._____________-.--____-___. <br /> No. of compartments---------- ---------------Size--------------------------------Liquid depth--------------------------Capacity--------------------- <br /> p X" <br /> Disposal Field: Distance from nearest weEl_/_Co..".Distance from founc1afi9.n__'1;?.47------Distance to nearest lot line---A/0--- <br /> Number of lines_________ _.--._----/ Length of each line---- -------------1J#------.Width of trench_c,;?.��--------------------- T <br /> Type of filter materiaI__s%___ �4_ __Depth of filter material----X8------ Total length_----- 2_4P------------------------- <br /> fo nclation- --_ <br /> 3 <br /> Seepage Pit: Distance to nearest well-- -----!Q-------- f m Distance ------------- * Distance to nearest lot line---/4:2 - <br /> Number of its----___/-----------Lining material____ _Size': Diameter.___,33----------Depth------4__? ----------- <br /> Cesspool, Distance from nearest well______-______--_Distance from foundation--------------------Lining material_______----____-_______--_--_-___--_. <br /> ❑ <br /> aterial-------------------------------------- <br /> F1 Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. CA <br /> Privy: Distance from nearest well_____________________________ _-.-Distance from nearest building------------------------------- ---------- <br /> ❑ Distance to nearest lot line ------—---------------------I--------------------------------------------------------------------- <br /> Remodeling and/or -repairin (de'scribe):---- --- ----------------------- -----------------------------------------­---------------------------------------------------------------------------- <br /> ---------------------------­-------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> .1 1 4 <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, Stat laws, and rules and regulations of the San Joaquin Local Health District. <br /> 49 <br /> ------ -------- ------ ----------- --------------- -------- 0 <br /> (Signed)-------I--. -------- - --- --- wrier and/or Contractor) <br /> ---—----------------------------- - ----- -- ------ <br /> (Plot plan, showing size of lot, fon <br /> By:.....------------ ---------------------------------(Title)------ <br /> ...............�(�o�cafiian o system i r ion to wells,,buildings, etL, can be placed on reverse side). <br /> F2R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------------------- -------------------- ------------------------------------------------------- DATE- <br /> REVIEWED BY --------------- ----- ------------ K <br /> DATE ---------------------------------------------- <br /> BUILDING PERMIT ISSUED--------------------------------------------------------------–-------------------------------------- DA-TE------------------------------------------------------------- <br /> Alterations and/or recommendations:____----__._ --- - - -------------""`yam----- -r----------- ------------------­-------------- ----------------------------------------------------------- <br /> ---------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------I-------------------------------------------------------------------F---------------------------------------------------- ---------------------------- <br /> ------------------------------ --------- -------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------_....------• <br /> t <br /> ------------------------------•------------- <br /> ----------------------- ------ <br /> -------------------------------------------- -------------------------- ------ ------I- ------------------------------------ ----------------------------------------------------------- - ----------r--------------------- <br /> FINAL INSPECTION BYe;Z -- ------------- Date__.__?_-.Z/ -,d-------------------------------------------- <br /> SAN <br /> ,d-------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore'Street 814 North "C" Street <br /> Stockton, California Lod;, California Manteca, California Tracy, California <br /> ES-9-2M Revised 8-'59 r.p.co. <br />