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FOR OFFI E US "r <br /> i-jJ` 31 <br /> i- ----------------------- ---------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ....____.__ _.......... <br /> ------ --- ------------------------------------------ --- (Complete in Duplicate) <br /> Date Issued <br /> -------------------------------------------.___.__._._.__ This Permit Expires 1 Year From 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 JA LOCA ION... -�--:�-_-j---3--sack...v -o- Z?_------ `- ------------------------•---•-•-------------------- <br /> Owner's Name.. ... Phone. <br /> Address............... = <br /> Contractor's Name- Phone----------------------------------- <br /> ---------------------- --------------------:-----------------------•-•-------------. . <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ___ ___ Number of bedrooms 3_ Number of baths __SL_ Lot size .../0-- <br /> �.............................. <br /> Water Supply: Public system ❑ Community system ❑ Private �pth ro Water Table ,ap ft- <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay dobe❑ Hardpan ❑ <br /> Previous.Application Made: {if yes,date----------_-------__1 No [E�New Construction: Yes 11—N-0 ❑ FHA/VA: Yes 25---go ❑ <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 nearest ygsll> .-__Distance from foundation.../....... _.___.Materie�------------------------------------------ <br /> No. <br /> ___ _------ .!-_-No. of compartments-----_.�_______________Size__. a.-.X-.S` _Liquid depth_.J"`�._ -------------Capacity-_- <br /> Disposal Field: Distance from nearest well./00..______Distance from foundation.Aq-------------Distance to nearest lot line_4:.......... <br /> ®� Number of lines_______ '__.._____--________Length of each line___Z11_f___________-----Width of trench------ .................... <br /> Type of filter material-_"_±?_r`f!�____Depth of filter material----L4'__"'____.__.Total length....... a_.i______________________ <br /> r Seepage Pit: Distance to nearest well-JO-e............Distance from foundation-14.........___.Distance to nearest lot ine__jA_ _/... . <br /> Number of pits______---------Lining material_ Gct_C Size: Diameter----,33------------Depth------ S— -----------• <br /> Cesspool: Distance from nearest well____-__-•._._---_Distance from foundation-------------------_Lining material------------------------------------- <br /> El Size: Diameter------------------------------------ Depth---•-----------------------------------------------_Liquid Capacity-------------------------_-gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ <br /> 0 Distance to nearest lot line------------------------- ----------------------•-------------------•----•--•---•---------------------------------------------------------- <br /> Remodeling and/or repairing (describe):------------------- ------- -------------- -------------------------------------------------------•---------------•---------•---••--------------- <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 /> (Signed)---------------------------------------------------------------------------------------------------------------------------------------------- .-------(Owner and/or Contractor) <br /> Sy.............----................---------------------------------------------------------------------------------------------------(Title)--------------------------------------------------- ------ •Y <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-----j------ -------------------------------•---------------- DATE---_7---------a6__K--Z---------- <br /> REVIEWEDBY------------------------------------------ -----------•-••-------------------------------------------------------------------- DATE----------_-_---------------- <br /> BUILDINGPERMIT ISSUED------•--- - -----------------------------------------------–------------------- ---------------_- DAT ------ ------------------------------------------------------ <br /> Arations and/or recommendations: ` r - �.�' .r.- - ----------•-•---•-----.- <br /> ----------------------------------------------------------------------------------------­­­----------------------------------------------j <br /> ------------------ <br /> ..........................................I------------------------------------- <br /> -----------------------------------•-----------•--•------•-•.------••-----------------------------------------••--- ----••------•---------------------•-------------------_----------•------------------------------------•--- <br /> -FINAL INSPECTION BY:_.__L, 1_.- ------------ Date..... ------- ---. -------- <br /> ---- --- --- � <br /> ---�--- --- ---------- <br /> r SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Srreet 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED B-59 2M 5-62 ATLAS <br />