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4—R-5/A714 <br /> 0IE: ------ <br /> APPLICATIONFOR SANITATION PERMIT Permit No. ..!•.�• � <br /> ------------- (Complete in Duplicate) Date Issued -1 <br />------------------------------ <br /> This Permit Ex ires 1 Year From Date Issue <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descrl MM <br /> ed. <br /> This application is made in compliance with County Ord' ce N 549. <br /> JOB ADDRESS AND L CATION._---_" -110• " <br /> Phone--------------- ------------- <br /> Owner s arae-.._- <br /> -_ <br /> �"... - !_a?-� ' ---- Phone---..... ...........- <br /> Contractor's Name.------•-•---_----=�=--�----•--- ----='-•- <br /> Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Mto-tele❑ Ocher ❑ <br /> ---------•-- <br /> Number of l'u'ng units: :_-". Number of bedrooms.,y _/_- <br /> Number of baths _� Lot size . <br /> Depth To Water Table �s�tm <br /> Water Supply: Public system ElCommuri'ty system &`Frivate Fl, Clay Loam Clay ❑ Adobe ardpan ❑� <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ y w . ❑ FHA/VA. Yes [1�. NO ❑ <br /> Previous Application Made: {if yes date----------------- --1 No � New Construction: Yes o <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well..--T'----Distan�f� and Capacity__ _.- <br /> No. of compartments---- Sized._ ____------' .! Liquid depth. " <br /> ` -•---•- <br /> !Q- f r <br /> 4 Disposal Field: Distance from nearest well-__-�__---.Distance from foundat'on._- __ --!• _W dthcofttrench�s �n`-------------- <br /> // Number of lines � ength of each line_, , <br /> De th of filter material_. __ I___....Total length--- <br /> Type of filter material P <br /> ff <br /> Q.__.__.D s nce to nearest lot tin <br /> Seepage Pit: Distance to nearest well--_--"' '_._---.Distance fr fou at . � _ - yy <br /> Number of pits--- '..---•---- Lining material__ ize: Diameter __.-.-.-.---..Depth <br /> ing <br /> Cesspool: Distance from nearest well--_ Distance from foundation_-_.----- Lilnuid Capacity 1_--" <br /> ❑ Size: Diameter-- ------Depth--- --- q <br /> 1 Distance from nearest bui{din <br /> Privy: Distance from nearest well----------------------------- <br /> ❑ <br /> Dista -- --- <br /> 4 <br /> Distance to nearest lot line".---"_--.".__"" _-_-_ <br /> Remodeling and/or repairing (describe):-- <br /> - <br /> --------- ----- <br /> MM <br /> MM <br /> I her eb 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 rul and regulations of the San Joaquin Local Health District. <br /> .r - efor Contractor), <br /> Si ned <br /> Title - <br /> (Plot plan, showing size of lot, location of systern n e ation to wells, buildings, etc., can be placed on reverse side). <br /> j FOR DEPART ENT USE ONLY <br /> ir 10, <br /> APPLICATION ACCEPTED BY --_ <br /> ----- DAT <br /> DATE. --------•------- <br /> REVIEWEDBY-------------------------------------------- --- /- - <br /> BUILDING PERMIT ISSUED-------------------- - <br /> Alterations and/ r recomme tions•`1~ 5 -��1 -- ff ...._ - <br /> - ••-•------------------ <br /> -­--------------7----------------M------------- -------*----------------------------------- ---- ----- --- __1---------- <br /> -------------------- ----- <br /> -----------•------ ------- ----- ------ - <br /> ..-.--"... -------- <br /> FINAL INSPECTION BY:. ..-- --- - ---- ---- ---- --- -- <br /> - - - -- ' Date----- ---------•- ..... <br /> - --AN JOAQ LOCA EALTH DISTRICT <br /> 130 South American Street 300 West Oa Street <br /> 124 Sycamore Street 205 West 9th Street <br /> Stockton,California • <br /> Eocli,California Manteca,California Tracy,California <br /> E5 9 REVISED a-59 2M 5-62 ATLAS <br />