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FOR OFFICE USE: <br /> --------------------- -- <br /> _____-.. APPLICATION FOR SANITATION PERMIT Permit No. __.l ... . <br /> --------------------------- --------------------------- <br /> (Complete in Duplicate) c� 3 <br /> Date Issued ___.____1..�..��. ..�-� <br /> --------------------------------------------------- This Permit Expires 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 Ordinance No. 549. 003-0';0-1 2- <br /> JOB ADDRESS AND LOCATION f��,���/ - �'''.''t'`- =------- .__ .. ..... <br /> Owner's Name....--- - " _.__Y_ dr �jr._ _- Phon . �`� <br /> - ------•------------------••-----•--------_------•----------------- <br /> Address--------_-•--•-----.._�tf._.��� .�.._... a`a ----- ------------ <br /> Contractor's Name------«/ --A;, tl_------6-------------------------------------------------- Phone................................... <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: I--_- Number of bedrooms Number of baths'.----- Lot size <br /> Water Supply: Public system ❑ Community system ❑ Private- Depth ro Water Table .�fl ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam k Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (if yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ . FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> C <br /> Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material------------------------------------------------- C <br /> ❑ No. of compartments--------------------------Size------------------------•- ---Liquid depth-------------- - ---------Capacity------------•---•--•--- <br /> Dis field: Distance from nearest well./,"_ Distance from founds'tion...Iaa__._...Distance to nearest lot lined----._--. <br /> V Number of lines----- --------- ------------�-t►Length of each.line.— .-----------N------Width of french___ --__ ...--.---------------.... <br /> Type of filter mater i _ -sem Depth of filter material____�_9-.-.-_______Total length---fes____________________________ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line....________-__•_ <br /> ❑ Number of pits----------------------Lining material-------------_---------Size: Diameter---------_----.------_.Depth--------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__.________..__._.___,__.______----•- <br /> ❑ Size: Diameter----- --------------------------------Depth-----------------------------------------------------Liquid Capacity_-----------•-••-_-------gals. <br /> f Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_____.-.-_.._-__________•_--•---_______._. <br /> ❑ Distance to nearest lot line---------------------------------------------- ------------------_---------------------•-------•-------------------------------------•------ <br /> Remodeling and/or repairing [describe]---------------An/, - - ------------ ---- --- <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 /> Sined ....-•... c!�<s-e.._ ` -------------------------------------------------------------(Owner and/or Contractor) <br /> By:.....-- ...... ----------------------------------------------------(Title).......... , -------- ----------r- - ------- --------- <br /> (Plot 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_ --- -------- ----------------------••-•--------------------------------- DATE- -------------------------------- <br /> REVIEWEDBY----------------------------------------------- ------------------------------------------------------------------------------ DATE-------•--------------------------- •----------------.... <br /> BUILDINGPERMIT ISSUED--------------------------------------------------------------------------- ...... ------------------ DATE------------------------------------------------------------- <br /> Atterations and/or recommendations:----------------------------------------- --------------------------------._.---------------------------------------------------------------------------- <br /> ----_--•------•---=-----------------------------------------------•--------------•--------------------------------•--••---------------•- -----------•-------------.------...------------------------------------------------- <br /> -------•-------------------------------•---------------•------------------------------ ---•------------------------------•------•------------•----•-•----------------....-•-•---------_-.-----•-•-----------------------._.... <br /> FINAL INSPECTION BY:_ -. . ev1— . ----------------------- Date_.-3_._� �+ <br /> - ---------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Srreef 124 Sycamore Street 205 West 9ti,Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED a-59 2M 5-62 ATLAS <br />