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FOR OFFICE USE: k <br /> ------------------- <br /> ----- --- _ ---- - ------ <br /> - APPLICATION FOR SANITATION PERMIT <br /> Permit No. _ .. <br /> " _, <br /> r ------- ----- --------------- ---- ----------___.__ (Complete in Duplicate) t Date Issued --------....--�-•-- <br /> i <br /> ------------------------------------ <br /> This Permit Exeires 1 Year From 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 Ounce <br /> JOB ADDRESS AN L CAT{ N_!_.` OD _ `,.` <br /> Owner's Name_ �.... - - ---. . ..-----4----•-- ------------------------------------ <br /> ------------------------- Phone • - � 1 <br /> F � <br /> Address------. ------• t -- - -------- -----------•----------- <br /> ---------- <br /> ----- <br /> � lid ePhon <br /> ----------- �_. _ <br /> Confiractor's Name .. <br /> Installation will serve: Residence L'J Apartment House ❑ Comrzercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: ------- Number of bedrooms -------- Number of aths -------- Lot size -------- ------ ---------•.....-------- <br /> < Water Supply: Public system ❑ Community system ElPrivate Depth To Water Table 61 ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam lay Loam C] Clay E] Adobe❑ Hardpan 0 <br /> P M- <br /> - No Application Made: {If yes,date----------- No 17-1 New Construction: Yes M- No ❑ FHA/VA: Yes ❑ NO ❑, -f <br /> + <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:` -� <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> pc ank: Distance from nearest well-----------------Distance from foundation____.:-•-_--._.._-..Material--:_-__-_-------------.......------------=--_- � <br /> No. of compartments------------------------•-Size--------------------------- ---Liquid de th------------------------- Capacity ------ <br /> Disposal i Id: Distance from nearest well.._.___._____---Distance from foundation__------------------Distance to nearest lot line_______...__....- . <br /> ❑ Number of lines-----------------------------------Length of each line----------------------------.Width of trench---------------•------------------ <br /> Type of filter material-------------------------Depth of filter material-----------------_-----Total length--------.--------_-.----------.--------- <br /> r <br /> Seepage Distance to nearest welL_ QO---______Distance rn # undation__46_.f._...Dis#anc�/to nearest lot IinQ -`- <br /> Number of pits_______-----____Lining material_ �--Size: Diameter___3,3----------Depth_.._.-,T___............. <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material.___._______--_-_.__.-....._-__.-__-- <br /> ❑ Size: Diameter--------------------------------------Depth--------------------------------- ------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest.well______:--_. _----- "- Distance from nearest building__________________________________________ <br /> ❑ Distance to nearest lot line- --- ------ ----------------------------M..•M..­,------------------------------------- --------------------------------•----------- <br /> 7 <br /> Remodeling and/or rep •ring (describe):_-- -•-• . •--• • ---- <br /> ----------------------------- <br /> ' - <br /> - ------­---------­---------- <br /> 7 ­ <br /> ---------------------------------- <br /> ------ -• y, <br /> % <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 and regulations of the San Joaquin Local Health District. <br /> (Signed)-----------------------••--------- •--------....--••-------•--- <br /> ` -----------•------------------------------------------------------------------------•-•----- -------(Owner and/or Contractor) <br /> • <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 /> L ` - FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----------------------------------------------------- ------- / --` __ DATE-------`27 <br /> ----- ` ---^ <br /> REVIEWEDBY---•-------------------------- ------------------------------------------------- • --- --- ----•-•-•--•------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED------------•-----------------------------•-------------------------- ----------------------------. DA•TE-------.. ..---------•-•-------------------------• -------- <br /> Alterationsand/or recommendations:-------------------------------------- --------------------_------------------•------------••-----•-----•------._..........._....------------.........----• <br /> -•--•-•-----------------------•-•----- � ----- --------- <br /> ------------------ ---- <br /> ... - -- --- --------- <br /> - - <br /> FINAL INSPECTION BY----------------------------- <br /> Date... - — <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 5-59 2M 5-62 ATLAS <br />