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FOR OFFI E <br /> . _ -s--------------------- <br /> ______________:__.-_-_-_____-_..-_____..____-__-_ APPLICATION FOR SANITATION PERMIT Permit .No. ...J. <br /> ---------------------- --------------------- (Complete in Duplicate) /:�:A3 <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 AND-'LOCATION......-- `'_= <br /> ---------- <br /> Owner's Name <br /> el&=3-`'-- .t'------------ --�- -..t��_+r__l-[��----- -- -- j --�'�-"-`-.e'------� �-r-- -- Phone- --• ----�'��-�-.��?._ <br /> Address__. <br /> Contractor's Name_-- c .-. !T_i _ Phone_ , �c�'// <br /> Int /� •--...... <br /> Installation will serve: Residenc(�1 [� partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Q __,r% <br /> Number of living units: �Number of baths _._)__ Number of bedrooms __ /__ Lot size ..._ <br /> _ .?--�. <br /> Water Supply: Public system �ommunity system ❑ Private [_1 Depth To Water Table 4p- ft. __. ... -._ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe QHardpan ❑ <br /> Previous Application Made: (If yes,date____________________) No ❑ .._ New Construction: Yes ❑ No ®-,_FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> is tT :t Distance from nearest well_________________Distance from foundation-------------------Material-------------._-______-...__.._______._..___.___. <br /> No. of compartments--------------------------Size---------------•----------------Liquid depth---------------- ---------Capacity---------------.._-_- <br /> Di all Nal Distance from nearest welL.�l1zG--.-Distance from foundation._._I-0_ ......Distance to nearest lot line______. .. <br /> Number of lines----- __ !Length of each line_ --------------Width of trenchc_4_1��---- <br /> T e of filter materia r <br /> YP .ar_ �_, .Depth of filter mat ria)_.._ _ __ Total length..................�-0..r___•__. {� <br /> Seepage Pit: Distance to nearest welL_1`�0tKe-------Distance rom foundation._=_�'_ ------Distance to nearest lot line__._..�_�____­ <br /> Number of pits----- 1__- Lining material__1 o-G__ __-__-Size: Diameter___:-��--------------Depth__- --------- <br /> Cesspool. Distance from nearest well-----------------Distance from oundation--------------------Lining material.___-___.-___-____-__-_____.,...____ <br /> ❑ Size: Diameter-------------------•--------------_.__Depth-------------------__ __Liquid Ca aci z <br /> Privy: Distance from nearest well-_______________________________________________-Distance from nearest building--_-_________•_--._____-__--____ <br /> ❑ Di t nearest lot line------- <br /> Remodeling and/or epairing (desc -be)r---------- -- ------------------• -•------------- <br /> _ t <br /> ---A�c -- - ------ <br /> --•- -----•--- <br /> ----------------------------------- ---- --- -----•-----------�-------------------------------------------.._.. - ----- ---- ---•---•---------------- <br /> I hereby certify that1I have prepared this application and that the work wi! a one in accordance with San Joaquin County <br /> ordinances, S to I s, a d r s and regulations of the San uin Local Health District. <br /> (Signe '.... -. /i r--�� 1_ --+ <br /> - - - ---- - -�- -� -R --a---�` --I-�- L. ----- - - - ''���••n�F[�"�1d�r Contractor) <br /> Br• ---Ze � (Title)--- <br /> --- - --------- --- ------------------ <br /> --- •--------------- - � -- - ---- <br /> (Plot plan, showing size of lot, location of system in relation to _ 'dings�tc7, can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----- - - -- ------ C� _-------- --------•---•---------•---------------_ DATE_..--- - = <br /> REVIEWED BY.... ---- _ .. ------------------- DATE---•---------------- <br /> ---------------------------•--- <br /> BUILDING PERMIT ISSUED--------------------------------------- -•---------------------------- A------------------ DATE--------•---------..p-.. <br /> Alterations and/or recammendations:___1C --- __.� ` _ ,+zu —� Z �-dz , <br /> j ---------------=--- --------------------------------------- --------------------------------------------------..---------. ------- <br /> _ v,t� <br /> ----- ----- <br /> FINAL INSPECTION BY:.---'' l t --• ---(---------•'--- ---------------- Date---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> - - „ <br /> ES 9 REVISED 8-99 zM 5-62 ATLAS +"� ..�`��„ ,,' <br />