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.. `AOR OFFIC US <br /> ,�,.. <br /> APPLICATION FOR;"SANITATION PERMIT <br /> Permit No. ___ _. ..... <br /> ------- (Complete in Duplicate) z/ l <br /> This Permit Expires ] Year From Date Issued Date Issued __... _. _ ..... <br /> Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION__. /,v <br /> ------- ---- -- - -------------� � <br /> .�' ._. .. --• •--•••• -----------------­----------- <br /> JOB ADDRESS <br /> Phone--------•--•----•= ..-- <br /> Owner s Name.............:..•--•--------•-----.�_- �---•- ---�--.-�--.-.------- -------------------------------------------- <br /> :G''`1` �- ---------- ----------•--•. <br /> Contractor's Name } Phone <br /> Installation will serve: Residence [�Apartment House ❑ Commerci ❑ Trailer Court ❑ Mote! Other ❑ i <br /> nn <br /> Number of living units: _I----- Number of bedrooms .___l_ Number of baths __/... Lot size _._.Z -----.............../ .7.f_..._.._._ <br /> Water Supply: Public system ❑- Community system ❑ Private)A Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam/ Clay[a Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,dote___________________) No� New Construction: Yes No E] 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 /> Septic Tank: Distance from nearer+ well____ �__..Distance from foundation_--,",::;"-.` <br /> oundation_._- �_...__t)Iaterial___--�-��. ._.:...._.'........ <br /> [ '.No. of compartments----------- _-__Liquid depth-------fl...............Capacity....mvagp...... <br /> Disposal Field: Distance from nearest welL_.--$'G'_-Distance from foundation......k_i''......Distance to nearest lot line__._'_._._.-.., <br /> ( / Number of lines________ ______ ______ ___Length of each line_.--__/ :__ _ Width of trench-_�y11E <br /> Type of filter material._._ .__.Dopth of filter material...___$_______.Total length----_-_f!_.t ........................ O� <br /> Seepage Pit: #Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line_---------_-_---- <br /> ❑ Number of pits----------------------Lining material..---------------------Size: Diameter........................Depth_"\,1- _------.--.------- � <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------------.-....__-.-__-__------- <br /> ❑ Size: Diameter------•-------------------------------Depth----------------•----------------------------------Liquid Capacity-------.----------_-----•-gals. <br /> s <br /> Privy: Distance from nearest well-----------------------------------------.-------Distance from nearest building.............--_------------_-.--._-.-_-- i <br /> ❑ Distance to nearest lot line-----------------------------------------------------------N=---..----------------------------------------------------------------------------- <br /> E a'� <br /> Remodelingand/or repairing (describe)----------------------------------------------------- -----------------------------------•-----------------------------••-------------------------- <br /> ..--•------------•---------------"--•-------------------....-.---------------------------•----------------••••-•-•-•-------.•-•----------------------.-------------------------------------------.........---------------- <br /> I <br /> -------. .I hereby 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 rules and ula�ions of the San Joaquin Local Health District. <br /> v <br /> (Signed) % .�'� •?' - �`� ' Owner and/or Contractor <br /> By:------•--------•-_ ' :.. -------- --------------•--------------------;---:-•----•---•------- -------------- <br /> (Title)--------------------------................................... <br /> :_. <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i <br /> FOR DEPARTMENT USE ONLY <br /> `-------------------------------------------- DATE ---- ------------ <br /> APPLICATION ACCEPTED <br /> REVIEWEDBY-_ ---•--•-- ._....::.. ------------------------ -------------------------------------------- DATE-------------------------------------------=:-------------- <br /> BUILDING PERMIT ISSUED-----------------------------------------------------•--------------------------------------------- DATE.--•---------••---------------------------------------------- <br /> a <br /> Alterat'ons and/pr recommend tions: <br /> f-------- - ---a---------------------- <br /> 1 r <br /> ..-:::-.,� - . <br /> r----------.=--- ------------- <br /> --------------- <br /> ------------- ----------------- <br /> FINAL INSPECTION BY:.----- ....... Date------7---.3-------(...... <br /> 5AN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 144 Sycamore Street 405 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 6.99 YM 6-61 ATLAS <br /> I <br />