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... . 77-­� <br /> FOR OFFICE USE: <br /> . =t t -------------------------- APPLICATION FOR SANITATION PERMIT <br /> Permit No. --E-�=---i----.�-- <br /> -------------r---- (Complete in Duplicate) Date Issued. <br /> --^+�~ -- This-Permit Ex ires 1 Year From Date'lssued- µ <br /> Application is hereby made'to the San Joaquin Local-Health District for a permit to construct and install the work herein described. r <br /> This application is made in compliance with County Ordinance No. 549. ` <br /> ' ------- I <br /> JOB ADDRESS AND OCAT ON__ <br /> p ----------- Phone --------------- <br /> Owner's Name----- --.' ' ------------- <br /> -------------------------- ---------------------- <br /> '•• I <br /> - f Phone-------------------------------•---------------- t1 <br /> Address.------���1/'r------ ---- <br /> Contractors Name------"�'--- -------- <br /> Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _f---- Number of bedrooms A--_ Number of baths _�___ Lot size _ ___ ---------------•---- -------••- <br /> Water Supply: Public system E] Community system ❑ Private �epth to Water Tabledooft. <br /> Character of soil to a depth of 3 feet: Sand ElGravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[�Hardpan El <br /> Previous Application Madel' (If yes,date_____ ______________) No New Construction: Yes ❑ No �HA/VA. Yes'E] No, � <br /> TYPE OF INSTALLATION",AND SPECIFICATIONS: i <br /> ( p cesspool permitted if public sewer is available within 200 feet.) <br /> --' i -. ._._.� .. f - . <br /> Se tic,Tankie tic taDistance from nearest well_-.___._____..__Distance from foundation--------____________Material________-_____.._____._.--___________._____-__-- <br /> M <br /> 7/ No. of •compartments--- ----------------- ----Size----------•----; --------- Liquid dep}h Capacity <br /> Dis psal Feld: Dis`tance'`froi i nearest well___( ._.Distance from fcundafion_AQ__�'t___.Distance'to nearest lot line.._!__. <br /> �/ T e e - i' -------Length of pa line__.,,;V-------------- - <br /> �/� +f r ofrlines / \Width of trench---�---------------------------- (N <br /> /J Numbe �4 ,� �< <br /> yp f filter material.-_ /�¢fj+�-Depth of filter materjal--- - ----------Total length___ L -------•---'------ <br /> ,_ .� - i <br /> Seepage Pit: Distance to nearest.well_._/0_0-__.._-Distanoe from foundation----' Ile to nearest lot line-'-' <br /> Number of pits----- Linin — <br /> material_ G ---Size: Diamefer&.-�'------..Depth_,�>�--__-----_-------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material___________________________-______-- <br /> ❑ , Size: Diameter------- --------------- ----------Depth----------------------------------_ ---------------.-Liquid Capacity------------------ gals. <br /> ' __________________Distance from nearest building Privy: u • Distance from nearest well -------------- --- 9--:----------------------..--------------- <br /> � <br /> —. � . .. .--. _ ----------------------------------- <br /> ❑ f � Qistancefto nearest'lot�line----------- • --------------—--------------------- ----•-••-----.._..------------------------------- <br /> 1 --------------------------------------------------- <br /> Remodeling and/or repairing (describe)-------- --- --9 <br /> k ;1 ___________________ _________ <br /> --------------- ---.._.---- <br /> M1 <br /> ----__.---. .- � --------- 'll - ------------------------------------------------------------------------•--•-------•-------- -----------------------------------------------------•---------------- <br /> -- <br /> ! hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San-Joaquin Local Health District <br /> (Signed)-------------- ---------- - - ---�- --�-"-'-�-{f -- ------ -------------- <br /> r ------------------------- dor Contractor] <br /> By:--------------------- Title <br /> l ---------- -------( ) <br /> (Plot plan, showing size of lot, location of system in <br /> r ation to wells, buildings, etc., can be placed on reverse side). <br /> r <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- 'S------ ------------------- ------ 3 DATE - ' AP-A---------------------------- <br /> REVIEWEDBY---------------- 'I=------------------------------------------------------------------------ DATE <br /> BUILDINGPERMIT ISSUED--------------------- ----------------------- DATE------------------------------------------------------------- <br /> ------------------------------------------- <br /> Alterations and/or recommendations------------------------- ---------- <br /> ------------------••-----•--•------------•---- <br /> ;, <br /> ---------------------------------------- <br /> y. --------------•---•---•------ ----•- <br /> S <br /> m . . _ .. <br /> FINAL INSPECTION BY:..__L:.- Date ' -- <br /> SAN,JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street3 ,. +y124'Sycamore Streef� 205 West 9th Street. <br /> Stockton,California ; Lodi,California Manteca,California Tracy,Callfornla_1 <br /> E6.9 REVISED EI.89 P.0.120.2M 6.613' <br />