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- <br /> F R OFFI US : � <br /> ---- ----- - / -----��' <br /> _ ___ .___._.._------------ <br /> APPLICATION FOR SANITATION PERMIT Permit No. _. .............._..... <br /> (Complete in Duplicate) <br /> Date Issued <br /> ----------------------- This Permit Expires 1 Year From Date Issued .._. _...../..... 1 <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 C unty Ordinance No. 549.- <br /> JOB <br /> 49.-JOB ADDRESS AND LOCATl •3• 3 5a,Jv � ,c^.� <br /> r- � �v0 <br /> Owner's Name..:.. _ ......... -------------------------------•-- --- ----------------- Ph e---•------------....---------------- <br /> Address - r.. <br /> Contractor's Name---- -----------------------------------------••---- Phone................................... <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 1 <br /> Number of living units: Number of bedrooms __ZNumber of baths .__1.. Lot size ..._ --------------------------------------- <br /> Water <br /> -...................Water Supply: Public system 1,E] Community system ❑ Private E01<1pth to Water Table ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Send Loam ❑ Clay Loam ❑ Clay ❑ Adobe W<ardpan ❑ <br /> Previous Application Made: (if yes,date___._____.___.___._) No New Construction: Yesto ❑ FHA/VA. Yes ❑ No 52"__ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' <br /> Septic nk: Distance from nearest well--- �.____Distance from foundation----1. ---------Material___--_ ..... .............. <br /> 21 No. of,compartments---------- y Size---- __ _k3 Liquid depth__.____+`.._______._Capacity-8W. <br /> Dis osal eld: Distance from nearest well-. <br /> p _-_--.Distance from foundation----J4�------_Distance to nearest Int line--,--- <br /> Number of lines;_�..___�_________--____ Length of each line._-----50�-------------Width of trench.___-..�iF.. . <br /> �_____.___..._ -� <br /> t sI <br /> Type of filter materia]._. . Depth of filter material.......��____-----Total length...../_j�_Q--i--------------------- <br /> Seepage Pit: Distance to nea est well______________________Distance from foundation....................Distance to nearest lot line---------------_ <br /> ❑ Number ofr pits....... -----------Lining material-----------------------Size: Diameter...:....----------------Depth----._--------------_.----- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----------..___._._--.....__.______._ <br /> ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity <br /> Privy: r Distance from nearest well--------------------------------_----------_-----Distance from nearest building______.___---__-_----_---_-______________. <br /> Distanceto nearest lot line--- --- ---- ---------- -------------------------•---------...------------•----...---•-----------------._.._..----...------------•-------• <br /> t <br /> Remodelingand/or repairing (describe):i----------------------------------•- ---•-•--•-•-----------------------••--------••---...---....--••------------------------------------............•-- <br /> , II <br /> 11 <br /> ------••---------------------••-----•-------------•---------•-•----------•--------•-••------•---------•-------•-•----------•-------------------- <br /> t!. I t <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 /> i <br /> (Signed)----- ------ --------- -----•-------. -----------------(Owner and/or Contractor) <br /> I -------------------------------------------------------------------------- -----------------------------------------------------Title <br /> (Plot plan, <br /> showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY i <br /> APPLICATION ACCEPTED BY._- ____ .?___ <br /> ___ DATE__ <br /> REVIEWED BY-------------------------- ••...........--. DATE <br /> BUILDING PERMIT ISSUED----------------- - --------------------------------- DATE----------------------.....---------------------------------- <br /> Alterations and/or recommendations:.-------•------•----------------------------------------------- --------------------------------------••-----------•------------------------------------------ <br /> ..........I------------------------.--------- ---------------------­-- ---------------•••---••------- -----------------------------------------------------------------------•----------------------------•----...... <br /> FINAL INSPECTION - .:--- - Date.... <br /> SAN JO QU L AL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 Wast 9th Streit <br /> Stockton,California Lodi,California Manteca,Carifornia Tracy,California <br /> E8 9 REVISED 8.99 YM 6-61 ATLAS <br />