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F,OR OFFICE�SE: <br /> - _ <br /> APPLICATION FOR SANITATION PERl! IT Permit No. -A. ......... <br />---------------- ------ <br /> -------------------------- (Complete in Duplicate) 1.7 ..�5 <br />--------------------------- Date Issued <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. <br /> --------------------------- ......_........m----------------------------- <br /> JOB ADDRESS AND LOCATION...-- 44, q l`J---------il.0................... ........I---------- <br /> LTJ d� <br /> ......... ...... ------------------------------------------------------------------ Phone.. 3 03- <br /> Owner's Name------- <br /> Address.....---------------- ------------------------_-- ------j---------------------- <br /> ---------------------------------------.-c-.-.-. <br /> *----------------------------- <br /> ;�� Phone. <br /> Contractor's Name.._- A- -------2-e----- ------- ------------- <br /> Installation will.serve: Residence [!R-'Apartment House [I Commercial [) Trailer Court [3 Motel [] Other 0 <br /> Number of living units: .-j.___ Number of bedrooms --r___.'Number of baths -J... Lot size -----I-......... .. .... .................... <br /> Water Supply: Public system El Community system El Private 5j--Depth to Water Tableilk . it. <br /> Character of soil to a depth of 3 feet: Sand [] 'Gravel E] Sandy Loam 0 Clay Loam 0 Clay F] Adobe�ardpan <br /> Previous Application Made: (If yes,date----------- --------) No 8-----New Construction: Yes &--ko E] FHA/VA. Yes 0 No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public 41 sewer is available within 200 feet.) <br /> ��J ------- <br /> No. of compartments-------- _ ---Size_ ---- <br /> Septic Tank: Distance from nearest well__________----------­Distance from foundation-----M----------Matoal--- <br /> Liquid clep�h......:S_.............Capacity..,. <br /> -Z �L <br /> Disposal Field: Distance from nearest well-._ __O------Distance from foundation...,. 1 Distance to nearest lot line...------------- <br /> Number of lines___________t__ __--- Length of each line-OU-_ .1 Width of trench 2- <br /> Type of filter mate rial...&A-CA/-----Depth of filter material----/A------ ------Total length--------------- ..... ---------------- <br /> Seepage Pit: Distance to nearest well---1-64----------Distance from foundation----- _.Distance to nearest lotAne__:� ...... <br /> ----------- If <br /> Number of pits-__---/--------------Lining material.-_n A- , -Size: ameter-----3- --------- <br /> ------ Di Depfh. .Z <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-------------------Lining material_-__.______.-_______-------_-______-- <br /> Cl Site: Diameter.-------------------------------------Depth_.----------------•_-----------------------------Liquid Capacity-------------------_----------gals. <br /> Privy: Distance from nearest well.----------------- -----•----•------•----------.-Distance from nearest building----•--------------•-----------••-------.. <br /> Distance to nearest of line-------------------_------------------•---------------------------------------------------------------------- -_------------- --------- <br /> • <br /> Remodeling and/or repairing (describ ------------------ --------••---..................... --------------*--------------------------------------- <br /> - ----------------------------------I............I----------------------- <br /> --------------------------------------------- ------------------------------------------------------------------------------------ <br /> -------------------------------------------------- ­ <br /> ---------------------------------------------- ..................-------------------------------------- ------------­------------------------------------------------------I---------------------------------------- <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 /> -her and/or Contractor) <br /> ----------------------------- (Ow <br /> ............. V <br /> ... ....... .. ../-----------_ <br /> (Signed) —------------------- ........ <br /> ............... <br /> �j <br /> -- <br /> U ---------------- ------------------ --------------------------------{Title)_ .. <br /> - <br /> ......... .. .. .... .... --------- <br /> -R"i <br /> (Plot plan, showing size 0 of, location of system in relation to wells, buildings, etc., can be placed on reverse si <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY-------------- ---- ----------------------------------------------------- -------------------- <br /> REVIEWEDBY-----------------_-----_-------_--- ----- ----------------------------------------------_---------------------------. DATE------------------------------------------------------------- <br /> BUILDING PERMIT ISSUED_...._..----------------------------------- <br /> DATE------------------------------------------------------ <br /> Alterajpris and/or re enclatilons---------------- -------------------------------------------------------------------------- <br /> 11! 111:91 <br /> -- - -------- <br /> 7�---------- ................. <br /> /_�/r-- - ------- --------- ------- ----------- <br /> ­------------- ..................................... . <br /> ---------------------------------- -------- -------------------------- ---- -- <br /> ----------------- - -------------------------- <br /> j <br /> ----- ----- ----------------------------------------------••••---------------------------------------------------- ---- .. ....... -------------- <br /> Da e-- ----------- --------------L—---------- ----------------------- <br /> ---- - ---- -- / <br /> FINAL INSPECTION BY:..--- ....... -------------- ------------- t -- ---- <br /> SAN JOA(?UIN LOCAL HEALTH DISTRICT 0 <br /> 130 South America Street 300 West Oak Sfro*t 124 Sycamore Street 205 XHIB -T <br /> Stockton,California Lodi,California Manteca,California Tra <br /> ES 9 REVISED 8.59 2M 5-61 ATLAS <br />