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FOR OFFIC USE: <br /> APPLICATION FOR SANITATION PERMIT Permit No. .....f.-_--------- <br />------------------------------- ------------------------ (Complete in Duplicate) <br /> Date Issued <br />--- ----------------------- <br /> - This Permit Expires 3 Year From Date Issued <br /> - ....... ........ Z <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construc and install t e work herein described. <br /> This application is made in compliance with County Ordinance No. 549. r <br /> JOB ADDRESS AND LOCATION-��--}/------------A -- Gt�`2�p Y{ ` .bin. �� " ..F . <br /> Owner's Name----;11_ .WkTl------71,46 -- _ •--•-------------------- ---•----- Phone................... ----------- <br /> Address-......... _ ': - _ - . : ----------------------------------------------------- -----------------.....-•--- --------------••-•-•----------------•-•----------------------------- <br /> Contractor's Name..------ ----Q ---=�.- _7 •-•--•--- -----------•------•---•----------= ...... Phone----------------------------------- <br /> Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: J---_ Number of bedrooms .-3--- Number o baths .-1..... Lot size ....... P. ------------------------------- <br /> Water Supply: Public system ElCommunity system ❑ Private Depth To Water Table .-62 ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ S dy Loam E] Clay Loam ❑ Clay E] Adobe Er Hardpan C]Previous Application Made: (if yes,date----------- --- ---- No [ New Construction: Yes ff"No ❑ FHA/VA: Yes 2No ❑ <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 well__6_0-......_Distance from foundation_-/P_(_-.------.Material__---- _-=------------ - <br /> No. of compartments-------: - - p d4G <br /> o .-•---------Size---�-X�-x--�F•----: --- <br /> -._Liquid depth �---------- --- ---capacity_ -------V----- -• � <br /> Disposal field: Distance from nearest well-.,-_a------_Distance from foundation.-- -------------Distance to nearest lot line.4..... C� <br /> ©� Number of lines------------- Length of each line---77--------------__.Width of trench---�-��.................... <br /> `�---_--�---- • Depth of filter material-.��---------------Total length..._.1�_�...-..-------....---------- <br /> Seepage <br /> _-_-- <br /> Type of filter materiaL_._.j�BG�.-----_- p - - <br /> Seepage Pit: Distance to nearest well--- ---------Distance from foundation_jQ.............Distance to nearest lot line--''SM....... <br /> ._ <br /> ❑/ Number of pits-------------------Lining material•._. / --.--.Size: Diameter----33-- _..-- Depth-------' �____..---_----_-- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----------------------------------_- <br /> ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. ; <br /> Privy: Distance from nearest well--------_--_------------------------------------Distance fromwrest building ------•---- <br /> ❑ Distance to nearest lot line----------------------------------------------- -------------------_- �----- ---_---------•-----------------•----------- <br /> Remodeling and/or repairing (describe):----------------------------•-------------------------------•---•--------••-•----------------•--•----N,------------------------------------ ....... <br /> ------------------------ _------------------------- •-------••-----------•----------------------•--•---------------------------•-------------=--------------- ----------------------------------------•----- <br /> ------•------------- ------_---------•---------------•------------_-----•-••---•----------•-------------------------•-•--------------------•----------=�-----------------------------.-------- <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 rules Vregulafjiofe San Joaquin Local Health District. <br /> Signed _.. - --------------------------------------------------------------------(Owner ar� /or Contractor)( } ----------- <br /> BY�; = --- -- ------ -------- ---- Title} - <br /> C (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-------------------------- DATE_... ...... ------------- --•-------------- <br /> -----------•-----------------•----•----------.-•--- <br /> REVIEWEDBY------------------------•--------------------------------- ---------------------------------------------------------------- DATE------------------_-- ------__-_-------------------- <br /> BUILDING <br /> -----.....-_-------------------- <br /> BUILDINGPERMIT ISSUED----------------------------•--------------------------------------------------••------------------- DATE------------------------------------------------------------- <br /> Alterationsand/or recommend'ations:---------------------------------------------------------------------------------------------------•------------------------------------------- -••------------ <br /> ---------------------------------------------------------------- ---------------------------------------------------------- --------------------------------------------------- ------------------------------. <br /> FINAL INSPECTION BY:..-C-....._�'c S---- -- -----------1­• Date.....k.V-_- I-k -16: -: -------------------------------- <br /> 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 9.59 2M 5-62 ATLAS <br />