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FOR OFFICE USE: -4- <br />------=��-"-x-� <br />------------------------------------------ -------------- APPLICATION FOR SANITATION PERMIT Permit'No. .•--� - 7- •-�� <br /> ---------- -------------------------------------- (Complete in Duplicate) 9- 7-& 2— <br /> This permit Expires 1 Year From Date Issued Date Issued -------------•.. ... <br /> r 7�- Q&-0-07Application 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 County Ordinance No. 549. <br /> r-,.-,. E. ST- - j <br /> JOB ADDRESS AND LOCATI N-___---4,4- -l - !a-. Wu•!'� A P3 � T <br /> ----- ----------------------•------------ <br /> Owner's Name n ' --------•----------------------------------------------•"-----"-------------- Phone•-----•----•--------------•--------- <br /> Address............ie4,�Q.??.._ ✓` � <br /> Contractor's Name.........'---- -------4- -••-f--------------------------------------------------------------------------.-........ Phone.......•-• ------•--------••------ <br /> Installation will serve: Residence, )Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __ :... Number of bedrooms _-jZ_ Number of baths ---I--- Lot size .....60�C,��- -._----------------------- <br /> Water Supply: Public system 2--60mmunity system ❑ Private ❑ Depth To Water Tableloa ft. <br /> Character of soil to a depth of 3;feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe RTOOHardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No L'J New Construction: Yes gfo No 0 FHA/VA: Yes 11"O'No ❑ <br /> TYPE OF INSTALLATION AND,:SPECIFICATIONS: _ <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) / <br /> 1 01 <br /> I/ <br /> Septic mak: Distance from nearest well--��__Distance from foundation-�--------------Material__� _•,""--•"-- i <br /> [ ' No. of compartments Size-_-_-- -- - tl-_- T r Ca aci 0 0-" <br /> P c1 Liquid depth-- P ty-9 <br /> CY <br /> • <br /> Disposal Field: Distance from nearest well ------Distance from foundation---I-Q_-t"-....""-Distance to nearest lot Ise- ---_ -.___.. <br /> Number of-lines_-_--_:_I-----------------------Length of each line...._L-_Q.--"-----"-_-----.Width of trench---7:"j!.....------------------ ' <br /> Type of:filter„material__- - ---Depth of filter material------ _"---------Total length.._-- ----------------------- <br /> r � � <br /> Seeps a Pit: Distance to nearest well--- ------Distance from foundation__. ._-_._--._-.Distance to nearest lot line_- --...... <br /> -----Linin material--�a-c,k--------Size: Diameter---X`----------Depth------ -d �--•-•f------- i�T <br /> Number of pits.------�------ _ g <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- <br /> ❑ -Liuid Capacity - r Size: Diameter--------- ----- --------------•---.-Depth-------- ------------------•----------------------- q P tY-------------------�-------gals. rn <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------------------- <br /> ElDistance to nearest lot line---------------------------------- ---------- - ••---------------------_••---------------------------------------•----•-•--------------------- <br /> Remodelingand/or repairing f describe}-----------------------------------------------•-----••--------------•----"----------•-•--------- ---------------------------------•--------------------- <br /> 1 <br /> ---------- ---•--------•---•-•-•----•-----•---•----- •------•--------•------------------------------------•-----------------------•---•-----------•-------------------•------------------------------------------- <br /> I <br /> ----------------------------------------------- ------------------ - --------------------------------------•-------------------------------------------------------. _1----------------------------• •----------------- <br /> 1 <br /> I hereby certify that I have prepared this applicat n and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of Sa Joaquin cal Health District. t <br /> (Signed) `--- ---------------- - ------ --- ------= - ---------------------------------------------------------(Owner and/or Contractor) <br /> By:------------------------------------------------- ------ ----- --- -------------------- ------------------------------(Title)-------------------------------- .-..---------------------- <br /> (Plot plan, showing size of lot, location ` s in relation to well buildings, etc., can be placed on reverse side). <br /> ( FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- C--E----- �-------------------------------------------------------------- DATE---- -. _ <br /> REVIEWEDBY---------------------------------------------------------------------------------------------------------------------------- DATE <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- <br /> Alterations and/or recommendation •--- <br /> --- ----r­_ <br /> --- -----------------------------------------------------------------------------•--• <br /> i <br /> FINAL INSPECTION BY:.. ------------------­----- - --------- -------------- Date........-_"f--------- / <br /> SAN AQUIN 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 /> ES 9 REVISED B-59 2M 5.62 ATLAS <br />