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FOR OFFICE USE: <br /> --------- APPLICATION FOR SANITATION PERMIT Permit No. . ....1.1..... <br /> (Complete in Duplicate) ��7, G Z— <br /> --- ----------- This Permit Expires 1 Year From Date Issued <br /> Date Issued ........1........._.. <br /> Application is hereby made to the San J in ceAlth District fora permit to construct and install the work herein described. <br /> This application is made in compliance nt POrdinance 5 <br /> JOB ADDRESS A ION--------_ ...----••......••---• ••---••---•....------••--.--•- <br /> --r <br /> Owner's Name Y ....... No. . <br /> �.... <br /> Address..................... <br /> --------••-•. ... ................ ................. ............... ................................ <br /> Contractor's Name-- y . ... --••..-�--- --------- -- - --------- ....L -r----A--.�\ rte..--•----••----- <br /> Installation will serve: Residence Apar ment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: ../___ Nyptber of bedrooms _f__- Number of baths ........ Lot size lf'� <br /> Water Supply: Public system Community system E] Private ❑ Depth to Water Table6G% ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay❑ be Hardpan ❑ fA <br /> Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ <br /> TYP INSTALLATION AND SPECIFICATIONS: <br /> (No septictankor cesspool permitted if public sewer is available within 200 feet.) <br /> ,ptiik: Distance from nearest well-----------------Distance from foundation....................Material................................................. \ <br /> No. of compartments--------------- -------- ize----------------------------=---Liquid depth--------------------Capacity....................... <br /> r <br /> osal Distance from nearest well Distance from foundation......--ter-.....Distance to nearest lot line..... .` <br /> Number of lines....../_ . _ Length of each line. _-�.. ._ _-.Width of trench.... 9 <br /> ,, �-- <br /> Type of filter materia_ _ -------------- _Depth of filter materia___....f_(�.._�otal length.................... ..Q...... ; <br /> Seepage Pit: Distance to nearest well____�L-__________ ist c om ou tion. ... .....DistancFrto nearest lot line..//. <br /> '� Number of pits_______ ___________Lining mat rials?._____------S ze: Diameter--c5 . .........,Depth.....c 1......__....... <br /> Cesspool: Distance from nearest well----------------- istance from un ation._-_.__-..--_.-_--.Lining material..................................... <br /> C] Size: Diameter--------------------------------------D th------------- ----------------------------------.Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well--- --__--__-_--_---_--___--___-______--._Distance fr m nearest building------------------------------------------ <br /> 0 Distance to nearest lot fin ---•-----•--•---------------------- ---------------- -•••--•-- ................................................. --•--•......._........... : <br /> Remodeling and/or repairin (describ f s.-'......---• -•---------------•---•--•--•-••-•---•-------•--•- <br /> ' ......................'�"f� <br /> 4 l �'= 1 '4�__ C L !�r c •.-.. -----• -`•------•--- <br /> I herebyY ce if at I hay prepared this application and that the work will be done in accordance wituan Joaquil County <br /> ordinances, St I ws an ru sand gulations the S n Joa uin Health District. <br /> (Signed)----- .... •--••------• . -- .... -•--• . �-------------------- ... �� '-------------------------- Contractor) <br /> By:.............................. � <br /> .------•-••••......-----•......--••-•------ . - -- ........(rifle) ---.......................... <br /> .....------------ ------------------------ <br /> ---- - <br /> --------- - --------------- <br /> (Plot plan, showing size of lot, location of system in relati ells, buildings, a c., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY......2ell ....................----- <br /> ...................... DATE------- ` 7.....(6 -2------------ <br /> - <br /> REVIEWEDBY.......................................— ------------------------------------------------•------------------------------. DATE............................................................ <br /> BUILDINGPERMIT ISSUED.............................................................—...................................... DATE............................................................. <br /> Alterations and/or recomme d'ations:..__..... ___ .......- -------__._ <br /> ............................-..............--------------•----------•------------------------------------------------------------ ----------- -••---•-•-•--•----....---•-••--•----•-------•----------•-••---•-•-----••-•-- <br /> .....••-•--.......•-•----•---••...........................•----•----•---=---------.....•-•-•-------------•---------------------•-------------•------•-•---••••-------•------•-••-•-•---------------------••--••--•--••----•--- <br /> ---•••••-••----•-------------------------------------------••-•--•••.....................................................--•-------•--•-----•--•••-••---•----•-------------•••••---•------••----------•••-•---••------•-•-- <br /> FINAL INSPECTION BY:......1-)R....-- t�!4._��__---------------- Date...... ' �j� � � ................................... <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 /> ES 9 REVISED 8-99 2M 5-61 ATLAS <br />