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., 'FOR OFFICE USE; <br /> --------------------------------------------------- <br /> ----------------------------------------------------- APPLICATION FOR SANITATION,.PERMIT Permit No. <br /> N <br /> -----------------------------------------------------------I---------------------------------------- �, i(Complete in Duplicate)-' , <br /> � <br /> - <br /> ------ This Permit Expires 1Yiar'FrOn4 Date lasued <br /> - Date Issued <br /> Application is hereby made to;the San Joaquin Local Health District fore-p-ermit to consMcf and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> 0 ols-1)13,0-- 0 d, <br /> 3 4; ,E,JOB ADDRESS =T!'ION. —-- e _ --�_ <br /> ---- ..... - ------- <br /> ----------- -- <br /> .................�7 <br /> Owner's ---- --------------------------------- ---- ---- --- ----- ------------------ Phone................ <br /> ...... --- - -, ------r`.........._....._._......___.._.........._._.._.I <br /> Address..................... .... ..w--- ---- - -- (2 <br /> Phone................................... <br /> Contractor's Name_ -----_-------------------------- <br /> Installation will serve: Residence Ape ment House ❑ Commercial E] Trailer Court,'.[] Motel [] Other ❑ <br /> 7 -o Water T�ble ....... t. <br /> *' . � <br /> Number of living units: -1-Number of bedrooms ... Number of baths --- ... Lot size ......... .......... --------------------------------- <br /> . .f <br /> Water Supply: Public system [I Community system E] Private Depth <br /> Character of soil to a depth of 3 feet: Sand [] Gravel E] Sandy Loam- Clay Loam [j pay [3 Adobe[3 Hardpan <br /> Previous Application Made: (If yes,date------ -------- No [-] New Construction: Yes ❑ No El.I. FHA/VA: Yes C] No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t <br /> ft---Mitferial-------------------- <br /> -S�-ptic Tank:`" Distance from nearest well____-__-__-----Distance from foundation,_----11-------r__.Material_______`__________.:_. <br /> ------- .......:!�....... <br /> El 'I- No. of compartments----------------_------.Size--------------------------------Liquid de�th'.44k'� <br /> ---------_._`:__:~___Capacity------.-._------------- <br /> Dis Field: Distance from nearest well___,54�------Distance from foundation___ -9...........Distance to nearest lot line.-_____.......:. <br /> Pt Number of lines____-_-_.-.•._ __________. Length of each line------ 54---!............. Width Of trench----d..........................." <br /> ------------------------- ----- -.1, <br /> Type of filter Depth of filter material,'­Z/1--- -----_.Total length........,, .d_________________________ <br /> ------ ion-_ lot line----- ......... <br /> Seepa (Pit. Distance to nearest well--___-G-Ot--- Distance from fgunda+' _JA......�3stance to nearestNu I -A _C� . .......mber of pits-------- -------------Lining material.. 4. ---Size: Diameter- Depth---------r ------------------- <br /> Cesspool: <br /> epth----------- ------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining-material------------------------------------- <br /> ❑ Size: Diameter--------------------------------------Depth------------------ f-----------------------------Liquid Capacity-----------------------•-••-gals. <br /> I <br /> Privy: Distance from nearest well------------------------------------------------!Distance from nearest building_______________..__..-........-..-.._____. <br /> Cl Distance to nearest lot line----------------------------- -------------t_i. ..............I................ r, <br /> ---------- ------------------------------------------- <br /> e�trfi <br /> ng an�/or repairing (describe):--------------------- ------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------I-----------,--------------------------------------------------------------------------------------i-----------------------6--------------------------------------- <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 A,- - <br /> District.. <br /> ordinances, State all.aw , nd rules and regulations of the San Joaquin Local ealth) <br /> ................ ------ ---------- ......... ----------- ..... ------------ ------------ ---------- ---------------- --------------_--_--------(Owner and/or Contractor) <br /> (Signed) <br /> . . .... . .. <br /> By:............. .. . ---------------- . ...................... ...... ----------------------*-------------------------- ------------of te <br /> -;;f I- "I tion ' f s" tem in r-elk-flo'o—n to wells, buildings, ef—c.,--E-an—b-e-,7pa-c-�d-,6-n-—reverse sidil <br /> (Plat plan,�showinq size ot, location 0 <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- Vii?4-4'114111�-------------------------------------------------------------- DATE---k`-i�G-------- .................. ........ <br /> REVIEWEDBY--------------------------------------------- --------------------I----------------------------------------------------------- DATE----------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED-------------4---------------------------------------------------------------------------------------- DATE------------------------------------------------------------- <br /> Alterationsand/or recommendations I.,---------- ------ ----------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------- ...........__------------------------------------------------------------------------------------------------------..........7------- <br /> ----------------------------------------------------------------------------------------- -------------------­­------------------------------------------------------------------------------------------------------ <br /> -----------------------------------------------------I---------I----------- ----------------------------------------------------- ------------------------ ----------------------------------------------------------- <br /> ----------------------------------------- ............... --------------­_----- ------------------------------------------------------------------------------------------------------- --------------------------------- <br /> FINAL INSPECTION ------------------- 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 Loclir California Manteca,California Tracy,California <br /> ES 9 REVISED 0.59 2M 5-61 ATLAS <br />