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FOR VEL OFFICE U E: <br /> >�C----------- ---- <br /> ___ ----S/—O....._..._ �__ - APPLICATION FOO SANITATION PERMIT Permit No. �.... . <br /> -------------------------------------------------------- (Complete in Duplicate) <br /> Date Issued ...... /� <br />- ---------------------­­-----------------------.--. This Permit Ex fres 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 NFos 9. <br /> JOB ADDRESS A CAT N._.Q � . <br /> Owner's Name______ - <br /> -� _ Phone---------------- - <br /> Address------ Qe-'----1°'-/-`-- ------------------------- ---------------------------------------------------------- ------------------.......................... <br /> - <br /> .r <br /> Contractors Name---------- --- ------------------------------------------------------ --•----- Phone................................... <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> f / � <br /> Number of living units: -1-_- Number of bedrooms .A--- Number of baths �l� Lot size -__________________________ <br /> Weter Supply: Public system. Community system ❑ Private ❑ Depth to Water Table 1(v ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ <br /> Previous Application Made: (if yes,date--------------------] No Z�'- New Construction: Yes M--Iso ❑ FHA/VA: Yes Z&- No, <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ,. <br /> Septic Ta Distance from nearest well------------ -----Distan e m foundation______+.� ! <br /> (No septic tank or cesspool permitted if public sewer is available within 200 fee <br /> �`� <br /> IP---•---M tof�-al _ °- ... . .. . <br /> . No. of compartments______ _.______._.._Size_ r __ ___,_._Liquid depth-__. Y Ca <br /> Dis osal old: Distance from nearest ell_ _ --�-- Distance from foundation.. __`" <br /> p � _ _ !._.._...Distance to nearest lot Iine._�.�... , <br /> Number of lines_______.. Length of each line___ ____ _________Width of trench__-____ . <br /> Type of filter materialyft_ _Depth of filter material- <br /> Type length_._.__/.�------------ <br /> See ag <br /> ---_____Seepag Pit: Distance to neares well..-__ ^_._____Distanc f fo ndation___- ........ t to nearest lot line_-_- <br /> _....___Dept _.Number of pits___ ______________Lining material_ ___Size: Dia meter_ _......---...------. pfV <br /> Cesspool: Distance from nearest well_______________ _Distance from foundation____.-_.---.__..__..Lining material____.___----___-_-_-_--_--_---_------ <br /> Size: Diameter--------------- ---De th--------------- ----Liquid Capacity............................ <br /> gals. ' <br /> Privy: Distance from nearest well __________________________________'-----------Distance from nearest building.............-_..._.._..._-___.____....... <br /> ❑ Distance to nearest lot line------------------------------- -----------------------------------•-•-•--.:. <br /> - <br /> Remodeling and/or repairing (describe):---------~ cd--- ' ........... •--------•-----••-------------------••------------------------------------- <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 les Id regulation of the n Joaquin Local Health District. <br /> i <br /> (Signed)............. : . --�1.....-----••-- -�.- ------- ------ •-- • - -•- ------------------------------------(Chwum-op;Vor Contractor) <br /> By:---------------------------------------------------------- -------•--------- =--....(Ti+lel ��f�-� <br /> ------------ <br /> (Plot plan.'showing size of lot, location of system in rel i o wells, buildings, etc., can be placed on reverse side). <br /> FO EPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------------ ---------------•-----------------••---•------- DATE—, - l r--------- <br /> -� <br /> ---------• DATE--------- •-•--- <br /> - <br /> BUILDING PERMIT ISSUED----------------------------------------------- DATE_--------• ------ -------------•-------------------- <br /> Alterations and/or recammen4t1gns:.-----••----••--•--- --------------------------- --- --=-- --=------�-�-�•r------.....----` �-.....--------------,;----------------------- , <br /> ------------------ �. `� ~'` • (� ` �`.__..- .:y�� <br /> F <br /> ......_...I-------- ;�--••`•-x�---= - - ` f ------ ---- ------ -----� c' � :K::l-E.�?�� <br /> •----•---------------------••-......... -----------..---•-----•----•-•-------------- ------------------------- <br /> FINAL INSPECTION BY: --------------------- 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 Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED B-99 2M 6-61 ATLAS <br />