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------------ ----------- <br /> /r. ' •'. a <br /> '-- : <br /> --- ---- -- 4 APPLICATION FOR SANITATION PERMIT Permit N <br /> L T (Complete in Duplicate) '" -' <br /> This Permit Ex Tres 1 Year From Date Issued 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 compliant with County Ordinance No. 549. , <br /> JOB ADDRESS AND <br /> i LOCA/�r _ --•---------- ---- -- --- <br /> Owner's Name--...- . � <br /> L <br /> --••----•---• <br /> ----- <br /> " <br /> Phone............... <br /> �-•-Address...............< o .. C <br /> • ow <br /> f -----------•------------------•---------•-------------••------ ----------- <br /> Con#ratter's Name..:................. . P.O 7 .S <br /> ---•-•------------------•-- - ' 0. .-;Z:Z-6 <br /> Phone._. . ............ <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial <br /> ❑ Trailer Court Motel ❑ Other ❑ <br /> Number of living units: -------- Number of bedrooms _-:--_-_ Number of aths -------- Lot size ............................................................ r <br /> Water Supply: Public]system ❑ Community system <br />{ Y Y ❑ Private Dep#h to-Water Teble� ft. � <br /> Character of soil to a depth of 3 feet: Sa Gravel ❑ Sandy Loam ❑ ClayLoam Clay p <br /> r ❑ y ❑II Adobe Hardpan ❑ <br /> Previous Application Made: (If yes,date.- - 6/--.) No ❑ New Construction: Yes- No <br /> TYPE OF INSTALLATION,AND SPECIFICATIONS: ElFHA/VA: Yes [:3 No <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Sept�T,�n Distance from nearest well-----------------Distance from foundation-.---_._.--._--_.-.Material <br /> _ <br /> � No. of compartments----___-- <br /> -•-----•--------Size-----------•----------•-----•---Liquid depth-------------------- .................. <br /> Disp qaI fi Distance from nearest well----------------- <br /> Dis#ante from foundation....................Distance to nearest lot line.._....._._...... <br /> Number of lines-,.--- :__--- Length of each line---------•-___-•- <br /> See T Type of filter mat ------- <br /> _ • --------.Width of trench--------- ------ <br /> } Depth of filter material-----------------'-.:-:.Total length---•------------------•----•--------..---. r <br /> r , <br /> # Distance to nearest well---��2-------------Distance.from foundation___�� r <br /> Distance to nearest lot line .__ <br /> ��� Number of pits..----._-_�-• ,�-,� -----. <br /> -------Lining material-.--_-[SOC't----Size: Diameter-_. - ..---- Depth------�!S_ 71 <br /> Cesspool: Distance from nearest well-----------------Distance from foundation.--------- <br /> Lining matenal.-... <br /> ❑ Size: Diameter. -------------------Depth-.,------------------- Liquid Capacity <br /> Priv q •---------------------------gals. <br /> Y: Distance from nearest well-------------------------------------------------Distance from nearest buildingEl = <br /> Distance to nearest lot line .a <br /> Remodeling and/or repairing (describe]--------------------------------- ---- <br /> •-----------------•- <br /> --------------•---- <br /> -------------•-------••-----•------------•-----------------------------••---------------------------------•---------••------•-------------•--•----------•-----•--•--••----•---•----•--- ---- ` <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with Saiz Joaquin County <br /> ordinances, State laws, and rules and regulation f t e San Joaquin Local Health District. . <br /> (Signed)-------------------------- - - F <br /> ------------------------ --. --.(Owner and/or Contractor.) 3 <br /> - --------- --------------------------•---------------------•---- <br /> (Piot 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_______________________ <br /> --- --- --- DATE-- <br /> REVIEWED !. 1..-•----••--------•-- <br /> EVIEWED BY------------ -- <br /> DATE [ ...--- <br /> UILDWG PERMIT ISSUED ------------------ ------•------------------------ <br /> ---- -- ------ ----------- ----------- DATE <br /> 11 <br /> Alterations and/or recommenddations_ ___:-._ __-._•- <br /> ----------------- <br /> . <br /> it <br /> . -•-- <br /> ......... .. <br /> ---•- ••• ---------------- <br /> ---------------------I................ <br /> ---------------------------------------1---------------------------------------- <br /> - ------- --------------------- -------------------------------------------------------------------------------------------------------i----------------------------------------- <br /> ------------------------------------I------- ------------I----------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> FINAL INSPECTION BY:-___----------- g, ,.6 <br /> Date 1_0. <br /> -------------- -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT ! <br /> t30 South American Strout 300 West Oak.Strew <br /> 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California <br /> Manteca,California Tracy,California <br /> EB 9 REVI9 EU e•59 2M 3•E1 ATLAS - <br />