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FOR OFFICE USE: <br /> ............................................ ............ APPLICATION FOR SANITATION PERMIT Permit No. ..1... 1. <br /> ------------------- '��\--••----- (Complete in Duplicate) <br /> --------------------- This Permit Expires 1 Year From Date Issued Date Issued ..... <br /> Application is hereby made to the San Joaquin Local Health District for a permit to cons uet� install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND OC ION)! - � - t, `-k! ` <br /> Owner's Name ---------- ho'P ne.................................... <br /> Address-------------oV!..... -----rte;--e-Y <br /> Contractor's Name ----------------------------------------------------------------------------------------------........................ Phone................................... <br /> Installation will serve: RVGdaceme -Apartment House ❑ Commercial ❑ Trailer-QAgh,* Motel ❑ Other ❑ <br /> Number of living units: .,.-__- Number of bedrooms ---j--- Number of baths .1.... Lot size __. Q..fit/ + ............................. <br /> Water Supply: Public system ❑ Community system ❑ Private 0 Depth to Water Table ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 10 Hardpan ❑ <br /> Previous Application Made: (if yes,date--------------------) Noja New Construction: Yes L' 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 /> DSP tic Tank: Distance from nearest well_,�A�___._Distance from foundation_ <br /> Material... ,--•-------- <br /> No. of compartments-----i,'l-----------------Size_x"y,t.::3.&a:_-.Liquid depth......................Capacity...6-* ........ <br /> Disposal Field: Distance from nearest well-4.10.........Distance from foundafion o............Distance to nearest lot line��....... i <br /> 00 Number of lines....�''--------------------._vv_..ff Length of each line_._... d----------------Width of trench...2 �'......_............. 1` <br /> Type of filter materia .4 ---Depth of filter material---,/F_-'*..........Total length._.. .Q.:......................... • <br /> Seepage Pit: Distance to nearest well------------- -------Distance from foundation....................Distance to nearest lot line................. <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------,Depth................................. <br /> Cesspool: Distance from nearest well.................Distance from foundation--------------------Lining material..................................... <br /> ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity............................gals. <br /> Priv Distance from nearest well-----------------------------------------------._Distance from nearest building <br /> ❑ Distance to nearest lot line--------------------------------------------------------------•-•---------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):------------------ --------------------------------------------------------------------------•--........................................................ <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 /> ordinanc a State Taws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signe ... eAl.."Ov.401tj--------------------------------------------------------- ------------------------------------------(Owner----------------------------------------(Owner and/or Contractor) <br /> (rifle) <br /> (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.-/,. ,21- --tAt���__ ----••------------------------------------------------- DATE--��'�-3-_ .---- <br /> REVIEWEDBY-------------------------------------------------- ------------------------------------------------------------ DATE............................... <br /> --------------BUILDING PERMIT ISSUED.............................................-----------------------------------------------------•• DATE............................................................. <br /> Alterationsand/or recommendations-------------------------------------------------------------------------------•-----••-------.....---•-----...-------•----•---•----•--•----••----•------••_... <br /> -•-•-•---•----•---•--•-----••-•----•-•••--••----••-•---•-•----•--•---•------•----•--------------------•-----------------------•-•-----••--••-••-----•----•--••••-----•-----•-----•-----•--•----•••....------•-••--•--••_.... <br /> --....-•----•-----------------------------------------•-----------------------------------------------------------------------------------•-----------------------•---•---...-•-------•----------------...................... <br /> ----------------••---••--•--••-----•------•--......----•-----------------------.....--------------------------------------•---•----......----------------------------------------------------------------------........-•---- <br /> -------------------------•-•--------------------------....-----•--------- --------------------------•--------------------------- -----•----------------------......------------...----------------•-------------••----------- <br /> FINAL INSPECTION BY: - ---------------------- Date..,0l`_'-c3?._4.2................................................... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Strut 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> E® 9 REVISED 6.89 YM 6-61 ATLAS <br />