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, I47 <br /> *y APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> 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__ <br /> - , -- - . . <br /> Owner's Name. . ._ tr. --- ------ Phone-------------- <br /> Address------------------------ <br /> ------------Address--------------------------------• •----- ------ _ ----- -• - -------- <br /> Contractor's Name -= L�sls�-` ..1 '---------------- Phone----------------------------------- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [j O rer� <br /> s <br /> Number of living units: ---- -_ Number of bedrooms -------- Number of baths -------- Lot size ----- <br /> ��^�r=ice-�---J--------------------- <br /> Water Supply:_ Public system E] Community Community system Private ��Dpfh to Water Table ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel.❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ <br /> Previous Application Made: Yes ❑ No �New Construction: Yes Ok'--No ❑ FHA/VA: Yes ❑ No �r t <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 weld_____-----------------Distance from foundation--------------------Material-----------------------------.-___._----.__--__. <br /> ❑ No. of compartments--=-----------------------Size--------------------------------Liquid depth--------------------------Capacity----- <br /> ---------------- <br /> Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line----------------- <br /> El - Number of lines----------------------------------=Length of each line------------------------------Width of french-------•------------:-------------- <br /> Type of filter material-------------------------Depth of filter material-----------------------Total length__---------_--.--___-__-----------.-__-.__ <br /> Seepage Pit: Distance to nearest ell-�� u�-bistance from fou ation--_------__---.Distance to nearest lot li e__.._~--__- <br /> �+ [� <br /> Number of pits......-------:__-Lining materia/ G Size: Diameter__ /W��.__-Depth_..._�07__----------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--.-_---_--_---_-_-.----._-__.______-. �y <br /> ❑ Size: Diameter---- ----------------- ------Depth------- ------------------------------=- ----------Liquid Capacity- --------------------------gals. <br /> Privy. Distance from nearest well-------------------------------------------------Distance from nearest building---_--_----_-_________---_-_-_ <br /> ❑ Distance to nearest lot line----------------- -- -------0_­ <br /> -------•-----------------•--•--------------------------------------------- -------------------" <br /> .10 <br /> Remodeling and/or repairing (describe): ___ `__ -_-_--le�_---�� � <br /> ------------•-----•--------•-•----------------------------- ' <br /> ---------- L+ sT-r n----... r �r--------�r-or f i �'d���- 7 <br /> -------------tir'-�- �- � -- <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 aneregulafi,,qns of the Sa Joaquin Local Heal District. <br /> Si ned$Y: 7 � {Title)_ ----------------------------------------- -- - placed <br /> (Plot plan, showing size of lot, I ion of system in relation to wells buildings, etc., can be laced on reverse sid <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----- --------- ------------------------------I---------------------------------------- DATE------ , 2 ----F- R, <br /> REVIEWEDBY --------------------------------------------------------------------------------------------------- DATE <br /> BUILDING PERMIT ISSUED----------------------------------------------------------------------- ------------------------ DATE-------------------------- <br /> Alterations and/or recommendations:--------------------------------------------------------------------------•----------------------------•----------------------- <br /> -•--------------------------------------------------•----------------------------------------------------------------------------------------------------- --------------•-------------------------------------------------•- <br /> -----------------------------------------------------------------------------------------------------------------------------•----------------------- ------------------------------------------•----•---------.._..__ <br /> -------•---------------------------•--- ----------•------------ ------------••-•------------------------------------------------------------•-------•-------------------------------- <br /> - ----------------------------- -----------------------------•- --------------------------------------------------------------•---------- ------- <br /> FINAL INSPECTION BY------------------ -- -- -- -------------------------------- Date- _r _���_ .._.1_------------ ) <br /> - -------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT. <br /> 130 South American-Street 300 West Oak Street y 132 Sycamore Street 814 North "C" Street <br /> Stockton, California •Lodi,:California Manteca, California Tracy, California <br /> ES-9-2M , Revised 1.57 F-P.CO. <br /> ' F <br />