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t FOR OFFICE USE: <br /> �4 <br /> .............. -----.__-..----. -___..-- - ._--- APPLICATION FOR SANITATION PERMIT Permit No. ...`............... <br /> ------------------- <br /> ---------------- <br /> (Complete in Duplicate) <br /> ! <br /> Date issued .. .---------------------------------------------------� ---------------.--- This Permit Expires 1 Year From Date Issued I. <br /> r 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 549. <br /> JOB ADDRESS A4 LOCATION <br /> ---------- -----------•--------•-•-------------- .................... <br /> Owner's Name... :.-.f�- 1---- -rC< r7 �.J <br /> ��,,, ------------- ----------....--------•-------•--------...-. Phone-//e--•i'�-�-�----•--- <br /> 7� Address...................... <br /> Contractors Name-- -- •= �'�'{ -._._ -- - .- -t� Phone l <br /> Installation will serve: Residence . Apartment House L� ommercial ] Trail ' Court ❑ Motel ❑ Other IQ <br /> M <br /> Number of living units: _ ---. Number of bedrooms -Number of baths . Lot size _.le� -.-..... :._./. .................... <br /> Water Supply: Public system � Community system E] Private ElDepth to Water Table ------ ft. <br /> Character of soil to a depth of 3feet: Sand ❑, Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: (If yes,date.- No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> yk <br /> No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> k:���Distance from nearest well_________________Distance from,foundation__-_-----___--..---.Material---_---..-_.-----_-_-.._.•_I....--------__---.-.. of compartments--------------------------Size-------._--.-_--_---____-------Li uid de th--------------- - -Ca aci 11 F d: Distance from Weare twell.. - -Distance from foundation__ �3 <br /> _-.......Distance to nearest lot line.........:. <br /> Number of lines------ ------- ---- -- - Length of each line---- -. .- _ Width of trench.-_-.... r� <br /> Type of filler material._ .. �-._- ..__Depth of filter material_..-..l ----------- <br /> '.Total length--------------•.-__._�� -.- --_.. <br /> li <br /> pag Pit: Distance to nearest --------- -----Distance from ,foundation---------...........Distance to nearest lot line----------------- <br /> _ Number of'pits..-------------. -----Lining material-----------------------Size: Diameter-----------------------Depth---------•--1 ------------------- � <br /> Cesspool: Distance from neare' sf'well-----------------Distance from foundation--------------------Lining material----------------- <br /> ...... <br /> ❑ Size: Diameter-------------------------------------.-Depth--------------------- ---------------------------­-Liquid Capacity-----------• ....------ <br /> gals. <br /> i Privy: Distance from nearest well-------------------___ <br /> ---------------_----Distance from nearest building---------------------_.__._-------------. <br /> ❑ "Distance to nearest lot line--.-___-_------------ <br /> Remodeling and/or repairing (describe):----------------f t <br /> • ----- <br /> ------------------• <br /> ----------- <br /> -• •-------- -- <br /> ----------------------••---------•------------------- ---••------------ --------------------•-•............... ------------ <br /> I .hereby certify that I have prepared this applications and that the work will be do in accordance with San Joaquin County <br /> ordinances, State laws, and rules end regulations of the San JT' Hea <br /> lth St Wed( �9 --------- . ;vt'----------------- wn o tontrac ) <br /> ey:. =---•---•--•-•-----• ------------------------•-- --• -,------ �r <br /> (Plot plan, showing size of lot,-location of system in relati to wells, building etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY � <br /> APPLICATION ACCEPTED BY -------------- DATE_--------- ` <br /> REVIEWEDBY-'----•--------------------------- - - ----------------------------------•----------------- -••••-•-------••-• DATE ..--... <br /> BUILDING PERMIT ISSUED------_.-----......-----------------------------•---•--•----•-------=---------1-------------------- DATE <br /> t Alterations and/or recommendations:---------------------• ---- ----- 111 -� <br /> -------------------------------------•--------------------- <br /> . <br /> -.---- <br /> "I------------ <br /> -------- <br /> --------------------------------------------------------.--------------------------------11---------iti----..-...._--------•••••---------__........------.....---....----•...._IF......... ......_ <br /> -...•..•--------__....-.--------------------_------ <br /> ---------------- <br /> ................ ............................ <br /> ....................----------------------- <br /> .....'i-'-------- <br /> Ij <br /> t a <br /> FINAL INSPECTION BY:-.V--. Date---------- - ---. .Z--. ------------------------------- <br /> SAN <br /> --------- ---------SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wort Oak Street °. 124 Sycamore Street 205 West 9th Srrio <br /> ot <br /> i Stockton,California -� Lodi,California Monteco,California Tracy,California <br /> k ES 9 REVISED 9.59 2M B-61 ATLAS <br />