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rVK VI-VICE USE: <br /> ------------- --------------------- ----------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) /y. <br /> - - <br /> This permit Exfres 1 Year From Date Issued t Date Issued <br /> - - ------ ---- --- <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and in all tk here dsscrl'bed,1{ <br /> gThis application is made in compliance.with County Ordinance No. 549, � <br /> —yi•e�"`"�'T`�-{+��, <br /> 70$ AD.'dRE55 A LOCA ON- <br /> Owner's Name_.___ <br /> G ._. r� ai <br /> ----------­--------- <br /> ---- •--••----------------- P one:. ..... } ; <br /> Address......... _ Zr <br /> -- --• ---- , <br /> Contractors Name-___--...___ <br /> t Phone . <br /> Installation will serve: Residents I Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: . <br /> ...____. Number of 6edroams .�%- Number baths __-L Lot size .._��_.�--e.•.--�--_--rv-.-y-c} __-•_ <br /> WaterSupply: Public system ❑ Community system ❑ Private Depth T Water Table -------- ft. *"h <br /> Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe E] ` Hardpan E]r t <br /> Previous Application Made: {If yes,d'ate-------------- I No ❑ New Construction: Yes <br /> ❑ 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 /> Septic" ank: Distance from nearest well_." ------Distancf, from foundation------�G-.P <br /> ---Material---- ______________________� <br /> No. of compartmen.ts_—---y--------------Size . +---- -- --Liquid depth___ -- ---------�----Capacity---/;kto_d <br /> y �• <br /> D•ispak Field; Distance from nearest well----��--��Distance from {oundation___.��_�._.___..Distance to nearest lot line__. __ <br /> of lines__—__ t ` ` ------ <br /> Number : - � <br /> f r ----------Length of each line......... of trench------X.Y <br /> Fa{ Type of filter ._._-.-; eof�ilte..r_._m <br /> material <br /> -----• <br /> sp : / - ---- length------- A------------------------- <br /> Distance to nearest-'we --- f, <br /> 0Seepage Pit: -----------Distancefrom`oSe : Distance fo•nearest lot line.._____---_:❑ Number of pits_& <br /> -:---------•------Lining material--------------------- ziameteDepth � <br /> or <br /> Cesspool: Distance from nearest well---------- <br /> -------Distance from foundation--------------------Lining material-__---____..._____-..___-_-_ <br /> `f <br /> ❑ Size: Diameter -.----------•--= =----------Depth <br /> ----------------------------------------------------Li..Liquid Capacity gals. <br /> .----- <br /> ! Y , Distance from nearest well-___._.---------------------------______________Distance from nearest building <br /> ❑ Distance to nearest lot line_________________________________________________ <br /> Remodelin repairing (describel___________________ I <br /> --------• -----------------------------------•------•------ <br />��- ••--•------------•------•---•- -•------------------------ <br /> --•-------.'----------------I----- ---------------_----•• •----------------------•-------- -----------------------------------I-------------------------------- " <br /> r <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, StatLlawand <br /> rules and 'regulations of the San Joaquin Local Health District. <br /> Si ned ' - _and or Contract{ 9 )------_----BY:----•---•- --------r- Contractor] <br /> (rifle) -- ------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> t <br /> FOR DEPARTMENT USE ONLY i <br /> APPLICATION ACCEPTED BY- -------------------4• DATE___ - ----------------------------------------------- <br /> BUILDING <br /> ------- ----------------- -•------------- - <br /> REVIEWED BY---------------------------------------�--- --------- _ <br /> ----------- -----------------•---------------•----------------._._ DATE-----------_----------------------• - -- - ------- <br /> ----------- <br /> UILDING PI=RMIT ISSUED ----- --- --- -- -- ••-------------- <br /> --- <br /> - - - - - - ---------------------•-•---------------------- DATE.----------•----------------------- - � <br /> Alterations and/or recommendations_________________._._-_-------_ <br /> :...............•-------------------------•----------------- ----•----- ----------------------•-•-----------------------------------•----------------------------------------•-------------------------••------- <br /> O-----------• 0 <br /> ------•-------- -•------------------------- ------------­----------------------------------------------------------------------------- <br /> ----• ------------------------------------- <br /> FINAL INSPECTION BY:.• .. ._ - _ J <br /> l; Date --- -------- ................ ------------------- ---------------• �- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Sweet 134 Sycamore Street <br /> � 305 West 9th Street <br /> Stockton,Cohfornia Lodi,California Manteca,California <br /> Troey,California <br /> E5 9 REVISED B-59 2M 5-62 ATLAS <br />