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r. 77 s <br /> FOR OFFICE USE: t•- <br /> 'r �` ---- - --- sc Permit No. .� -. <br /> 91 el ___ 4 = �� APPLICATION FOR SANITATION PERMIT <br /> ---------- ---- ------------------------------- (Complete in Duplicate) Date Issuedel -�1 <br /> ---------------------------------- This Permit Expires 1 Year From Date Issued <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 County Ordinance No. 549. <br /> JOB ADDRESS AND !LO ATI N_/ --------- ' <br /> . . �•-- <br /> l�Lf Phone. <br /> Owner's Name----- ----- <br /> Address <br /> --- <br /> Address--•..••--:W ... <br /> ----- ------------••-•-. .---------•----•-------------••-----------•. <br /> Contractors Name.. Phone----...... -••••-•--- <br /> Installation will serve: Residence Ua, Aparfment"-House ❑ Commercial'❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> i � ' <br /> Number of living units: __, __ Number of bedrooms -_ Number of baths ,lr_ Lot size . _. .lx�. --------•---•- --=-------- <br /> Water Supply: Public system ❑ Community system 11 <br /> [Private ❑ Depth to Water Table�t-> t. <br /> Character of soil to a depth of 3 feet: Sand-E] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Wo Hardpan ❑ <br /> Previous Application Made: (if yes,date--------------------) No � New Construction: Yes [r?-IAo ❑ FHA/VA: Yes [?J 'No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> from Septic twell_--' ------S _nce from dation_-- <br /> -----.Matrial. / <br /> No. of compartments_ - - ize��!X_ <br /> Liquid depth....... z -------.-Capacity-Al ---- <br /> Disposal Field: Distance from nearest well_._._-'�"'-_---Distance from foundation...*'.O.'Q-..----Distance to nearest lot line___.....:.. <br /> Number of -__:_ . ength of each line_/.QA`-_ .�•Vidth of trench.- -—-----••-----•• O <br /> Type of filter material _ pePth of filter material___, -.----Total length__. � --o----------••/ <br /> J <br /> ` Seepage it: Distance to nearest we11_____"-----Distance from fou ation-___ _____.Distance to nearest lot line. .............. <br /> Size: Diameter_.' p <br /> Number of pits------ ----•---- material � ..----De thy_ -_.---- <br /> Cesspool: Distance from nearest well______________-Distance from foundation--------------.-__-.Lining material.--------------------------------a 5 <br /> ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well----------------------------•--------------------Distance from nearest build ing------------------------------------------ <br /> ❑ Distance to nearest lot line-------- --------------------------- -•- ---------`--•--------•-----------------•-------•-------- <br /> a <br /> Remodeling and/or repairing (describe):----- •••-- -- -----•--•--------------------------------------- <br /> ----------­---­---------------------------------I............--­------------------------------­------------------------*-------------------------- ------------------------------------------------ <br /> i <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 and regulations of-the San Joaquin Local Health District. c <br /> (Signed)_ --f44� --- <br /> -------- <br /> ---------------(Awneasar Contractor) <br /> I <br /> (Plot plan, showing size of lot, location of system in r on to wells, buildings, etc., can be placed on reverse side). <br /> F EPARTME USE ONLY <br /> APPLICATION ACCEPTED BY-- - --• -- ------ -----•- - -- • -------------- DATE..-- --•• <br /> REVIEWED BY :.,. ---------------- DATE <br /> BUILDING PERMIT ISSUED---------_---------- - - DATE_..__.. -------•-•--------- <br /> Alterations and/or recommendations:___-- -_-.•-- -•- -----.-----••--- •- •- -----.'.._.............. <br /> - --------•------------------------------------------------- - -- x <br /> _------------------• ... --- �t <br /> -S 4 r <br /> ...ic>-!---------I---------►�ra.sopP_ITt�aJ4------- .. 1 - � "` ' <br /> :a:_- C' ,P _ r►�_... rs __. ----- --- ' ' -------- ��` ��.` ------------------------------------ ._...... <br /> ------- ----------------•-------------••------ -----•-- --------------------------•--------- -------- --------------------..... <br /> ( ,- Date - ------•----- <br /> FINAL INSPECTION BY:./_________ __ __----- __ <br /> SAN JO UIN L AL HEALTH DISTRIC <br /> 130 South American Street 340 West Oak Srreet 124 Sycamore treat 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 0-99 YM 8-41 ATLAS .. <br /> s <br />