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FUR OFFICE USE: <br /> ------------------------------------------------ <br /> -------------- ---------------------- -------------- APPLICATION FOR SANITATION PERMIT Permit No. .—Ib 7.?. . <br /> ------ ------------------:--_------ -------- - ----- (Complete in DuplicatelDate Issued <br /> ------------- --- -- This Permit Exs 1 Year From Date Issued i <br /> pire <br /> Application is hereby made to the San Joaquin Local Health District for a permit to onstruct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. 1 �S Z--oSO 6S <br /> JOB ADDRESS ANpZLOA 10N.______.. �---�. ---------------------------------------- <br /> w `O nets'Name _ U -- ----------------- Phone-------------------------------- - <br /> Address-------------- <br /> ---- ----•-------------------- - <br /> Address-------------- ----A ---- ?! - --- ' <br /> ---- ----•------ -------•--- <br /> Contractor's Name--------------- ---•-- - •------------•---•-----------•-------------- ----------------------------------------•--------------- Phone------- <br /> Installation will serve:. Residence ❑ partment House ❑ Commercial ❑ Trailer ;Court ❑ Motel ❑ Ot e N <br /> livingNumbeI �- - r of baths __:___ Lot;size !'___ -------------------------­ <br /> -2--e � <br /> f e 1-- - <br /> of <br /> - rt . <br /> Water Supply: Public system ❑ Community sytemm❑ Private be Depth to Water Tabl ►ft. <br /> : <br /> Character of soil to a depth of 3 feet: . Sand ❑ Gravel jy Sandy Loam ❑ Clay Loam❑ Clay [I Adobe E] Hardpan E]previous Application Made: (If yes,date--------------- <br /> 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.]w —, <br /> Septi Tank: Distance from nearest well__ __0.0+ Distance from foundation__ <br /> �1 No. of compartments---_ -_________ --Size__- --� ----Liquid depth------ : - - Ca acit <br /> Y --- __0- ----- <br /> Q <br /> Disposal Field: Distance from nearest well�l��_'�'_Distance from foundation____ istance to nearest lot line�_____s�_____ O <br /> Number of lines-----__-I----------------- -----Length of each line__-__k_v_5i__;- <br /> of trench___��._--_------_---------- <br /> µ.� yl <br /> Typo of filter material_^_ ___ _- -- ----Depth of filter material____/__�_�..___._Total length---/ca_0-____:___.-------------------- I <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 <br /> ❑ Size: Diameter-----------------------.---------------Depth-----------------------------------------------------Liquid Capacity----------------------------gals <br /> Privy: Distance from nearest..well_________________________..`_____________-_,:__Distance from,nearest.building_-_____---_________._________-__. <br /> ------ <br /> ❑ Distance to nearest lot line------------------------------------------------------------- <br /> Remodeling and/or repairing (describe)=-------------------------- <br /> - ----- ------------------------------------------------- -------------------------•----------------------------------•------- <br /> ----------------------•---------------•----------------------------------•-----------------------------------------------•-------- <br /> ------------------•---------------------------'----------------- -----------------------------------•----••--------••----------------------•-------------------------------------------------------------------------------- <br /> --------------------------------------------- --------------•----- ---- -- <br /> I <br /> ` <br /> iI <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County r" <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ,r <br /> - <br /> (Signed) 1br"- fid l-- ----------------------------- -(Owner and/or Contractor) I <br /> By:----------------- --------------------------------------------------------------------------(Title)------------------- . <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------------------- ------ ----- ----------------------------------------------------------------• DATE / •------------------------ <br /> REVIEWED BY --r--------- -- --------------- ---------------------- DATE <br /> BUILDING PERMIT ISSUED------------- ------------------ = DATE <br /> �. ------ <br /> Alterations and/or recommendations: --------------------------------------I------------------------------------------------------------------------------------------------------ <br /> -----------------•------------------ --------•-------------------- -------------•-------------------•---------------------------------- ------------------------------------------------------------- -•------------ <br /> - -- -•-------------•----------------- -------------------------------------------------- <br /> FINAL INSPECTION BY-- ---------------------------------- +� <br /> ------------- - - ---- Date - - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxeltan Ave. 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 3M 9-'63 F.P.120. <br /> i <br />