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FOR OFFICE USE: <br /> IjAPPLICATION FOR SANITATION PERMIT <br /> Permit No. <br /> 7----------------- <br /> --------------- --------- ---------------------------- (Complete in Duplicate) Date Issued --- <br />-------------------------------- ------------------------ This Permit Expires I 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. <br /> JOB ADDRESS AND LOCATFjON____..1?eV_7---- ---------------------------------------------------------------------------- ---------- <br /> Owner's Name----- -----7_� ------------------• ------------------------- Phone......--------------------------- - <br /> Address <br /> hone------------------------------------ <br /> Address......... .................. -------------�y--- .............................................................................................. <br /> _:��-----­---------------------- <br /> Contractor's Narrie...__------ -------------------------------------------------_----------------------- Phone---------------------- _----_---- <br /> Installation will server Residence (Apartment House E] Commercial [] Trailer Court 0 Motel 0 Other [3 <br /> Number of living units': Number of bedrooms -%g-. Number of baths -./-- Lot size -/­A.Ar�-- --­�7----------------------------- <br /> Water Supply: Public system ❑ Community system E] private VT'**Depth To Water Table <br /> Character of`soil to a depth of 3 feet: Sand [j GravelE] Sandy Loam [] Clay Loam o ClayE] Adobe Erlonard Pan <br /> Previous Application Made: Jlf yes,date----- . ....... No PRO' New Construction: Yes [] No2?'FHA/VA: Yes F] No 03 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> S?Pticjan Distance from nearest well................-Distance from foundation-----__---------Material-------------------------------------------------- <br /> No, of compartments-----------------------_Size------------------------------...Liquid clepth--------------------------Capacity-------_-------- <br /> -D os JOW: Distance from nearest _Q'._.-.....Distance to nearest lot line --------- <br /> is al F arest well._./.`1419__ Distance from foundation �/ <br /> XNumber of lines---------- ------ -Length of each line"'Oe.... W-------Width of trench___,r2_____ ----­-------------- <br /> f. Type of filter material. Depth of filter material---If------------Total length--------W-00"------------------------- <br /> Seepage Pit: Distance to. nearest well----------------------Distance from foundation------------...._.Distance to nearest lot line___________...... <br /> 0001�# 1�, I.,___--------.---I �... ------------------------ ------------------------------ <br /> -(# Number of pits----------------------Lining material- ----Size: Diamefgr ..Depth <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining-material-------------- ---------------------- <br /> 0 Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity--------------------------•-gals, <br /> Privy: Distance from nearest well------------------------------------------------Distance from nearest building-------------------_-------------------- <br /> Cl Distance to nearest lot line---------------------- ------------ ---------- ----------- --------------------------------------------------------- <br /> Remodeling and/or repairing (described______________- -- -- --------------------------------------------------------------------------- <br /> 4177-4--11 <br /> ------------------------------------------I-------------------------------------------------------------------------------------- - ­---------------------------------------------------------- ----------------- <br /> --------I-----------------------------------------------------I---------------------------------------------------- ----------------------------------------------------------I------------------------------------------ <br /> -----------------------------------------------------------------------------------------------------------------------------------------------------I----------------------------------------------------------------------- <br /> .1 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 /> (Signed -- --- ----------------- ----- - - -------------------------------(4Nwae@ma&44=Contractor) <br /> ------------------ Ale- <br /> By:...............................--------------------------------------------------- --- --------- - --------(rifle) ... <br /> ... ..... <br /> (Plot plan, showing size of lot, location of system in relall! o wells, buildings', etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- ---------- -------------- -- ---------------------------------------- DATE...kV -`---------- <br /> REVIEWEDBY----------------------------------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------- DATE------------------------------------------------------------ <br /> Alterations and/or recommenctaflons:---lVn_.7"-3. -------- ___---------------------- -------C___§�- --------- -----------­-1-------- <br /> 1�1-­------------------ <br /> --------------------------------------- ----------------1------------------------------------------------------------------------------------------------I-------------------------------------------------------------- <br /> ----------­­­--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------- <br /> ----------------------------------------- ----------------------------------------------------------- ------ ------------------- ------------------------------------­-----------­-I...........I.,........................ <br /> ......................................­ � ­­----------------------------------------------------------- ------------------------------------------------------------------------------------------ <br /> FINAL INSPECTION BY:..!;;......lizTt6-:5 --- ----- <br /> --------------------- Date-- 1\ ------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH[ DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED a-59 2M 5-62 ATLAS <br />