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FOR OFFICE USE: <br /> Ile <br /> APPLICATION FOR SANITATION PERMIT Permit No. .,� <br /> ----- --- - -------------------------- <br />- _ ------------ --------------------------- (Complete in Duplicate) 6 <br /> Issued <br /> _-------------- This Permit Expires 1 Year From Date Issued Date <br /> Application is'hereby made to the San dbaquin Locai Healthistrict for a permit to construct and install the work herein described. <br /> This application is made in complia a wi County Ordinance o. 544. <br /> JOB ADDRESS AND L ON .... .Q _ ,Z.a.. .------��� 1r/ -- ---------------------------------------------- <br /> ---------------- <br /> ----- <br /> ----•------------- •---•------------ <br /> Owner's Name fes} .. �A---- <br /> 7 ------------- --- Phone.........................---------- <br /> Address - -----s---'----� ...... r � "'� - _.... <br /> 4 • <br /> Contractor's Name ----d-�----•--•---•----------------------------------------------------------- Phone.------------.-------------------- <br /> Installation will serve: Residence Apartment House ❑ Comrhercial ❑ Trailer Court ❑ Motel ❑ Other [3 <br /> Number of living units: __ __ N e Iof bedrooms_. Number of baths /---_- Lot size .__.r______________________________________•__---_-----.-- I <br /> Water Supply: Public system Community system ❑ Private E] Depth To Water Table_7t. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand am [] Clay Loam ❑ C y ❑ Adobe ardpan ❑ <br /> Previous Application Made: (If yes,dote_____---------------) No New Construction: Yes LV No E] FHA/VA: Yes ❑ No <br /> I t <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted'if public sewer is available within 200 feet.) <br /> Septic T Distance from nearest w III________ 1-v_r__`�.Matefiai____.cc_-� vy C x ' : <br /> arc �___--Distance from. foundation <br /> [/ No. of compartments_____. _ ....... . ..Liquid depth:___ %jam.-._--_.-Capacity..... ....... } <br /> Dispos field: Distance from nearest well.._.^._Distance from foundation �......Distance to nearest lot line._.��..... <br /> Pr Number of line s.....__.f___-____...__-_Length of each line_._ � I y�y----Width of trench�_Y�1-..._.._____________ <br /> T e of filter material._J.�Z�___�pGe th of filter material_.-_/.Q-_______.Total len th____ __ <br /> Yp P g l <br /> Seepage Distance to nearest well_-__.��Distance from foundation_/p_----------Distance to nearest lot line _--_------ <br /> Number of pits----------2.--_ __Lining material.... U k'.Size: Diamete r_,X�_�-_________-Depth--g,-- <br /> ---------- <br /> Cesspool: <br /> epth__a ____.-----Cesspool: Distance from nearest well-----------------Distance from foundation------------.-------Lining material--_-_-_________-________________.___. <br /> als-P ❑ Size: Diameter--------------------------------------Depth.---------------------------------------------------Liquid Capacity-----------------------------gals:- <br /> Privy: <br /> rivy: Distance from.nearest well-------------------------------------------------Distance from nearest building_____--..-__--..____._-_._-___.__.._.__-. <br /> ❑ Distance to nearest,lot line----- ------------------- -----------------------------------------------•-••--' <br /> Remodeling and/or repairing (describer------------- --------• .. ...._-------•--•----- <br /> ------------------•--------------------------•---------•--------•------.- -----------------------------•-••-----------------------•----------• --•---------------------------- ------I----•------------------------ <br /> ------------------------ <br /> ._... <br /> ---------------------------------------------------------------=---------------------------------------------------------------------•--------------------------------------------.--------.-------------.---I--------------- <br /> I hereby certif t I have pr red this application and that the work will be done in accordance:with San Joaquin County <br /> ordinances, State aw a rules d gul tions of the San Joaquin Local Health District. <br /> __Owner end or ntractar <br /> (Signed)........-- -------------------------- -- ---------- ------------ . ( /- 1 <br /> By:------------------- -------- ..... ......._.I-------------- -------------------•-•------------------...(Title)--- ----------- -------- <br /> (Plot plan, showing size , location of system in relate o wells, buildings, etc., can be placed on reverse side). <br /> FOR EPARTMENT SE ON <br /> APPLICATION ACCEPTED BY ` ---------------- DATE----- --------------------- <br /> REVIEWEDBY--------------------------------- ---------------------------------- ------------------- DATE------------------ .... ------- <br /> BUILDING PERMIT ISSUED------ - -------------------'- <br /> DATE- -------- ----- ------------ <br /> Aheratons and/or recomme-ndations•::--_ :._l�5---- <br /> .-........._.. <br /> ------------------------------ ------------------ --------------------------------------------.. --------------------------------------.._. <br /> ---------------------------------------------------------------- ----------------------------------------------------- ---- <br /> --------------------------------------------­------------------------------------------ <br /> ---------------------------- ----------------------------------------------------------------------- --------------- -------------------------------­­­­........................................... ................. <br /> -------------------------------------------1------------------------------------------------ <br /> ------------------------------ --- --------------- --------------------------- ------ <br /> : <br /> FINAL INSPECTION B :.--- -- ...... -- - --- -- •- - --- -- --- Date----->-- -- -- - ----- ----- ----- -------- --------------- <br /> SAN JOAQ LOCA EALTH DISTRICT <br /> 130 South American Street 300 West Oak treat 124 sycamore Street 205 West 9Th Street <br /> It Stockton,California Lodi,California Manteca,California Tracy,California <br /> E5 9 REVISED 8-59 2M 5-62 ATLAS <br />