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FOR OFFICE USE: I <br /> ----- APPLICATION FOR SANITATION PERMIT Permit No. <br /> --- --- - - ----- -------------- <br />--------------I------- ----- ---------------------------- (Complete in Duplicatel L <br /> Date Issued ---------e-. <br /> - This Permit Expires I Year From Date Issued <br /> ----------------------- ---------------- --- to <br /> ADistrict for a permit to construct and i 4k�he�ir6described- <br /> �plication is hereby made to the San Joaquin Local Health Dis install the <br /> This application is macle.,in,compliance.with County Ordinance No. 549 <br /> B <br /> .............. .........................ADDRESS AND LOCATION--- ................. ... <br /> ................. ------------------------- <br /> Owner's Name.... ,ll ..______._ --------------- Phong;........ ... <br /> Address-------------- <br /> ------- ----- 05�......... <br /> Gontractor's Name---levw �­------------------------------------------------------- --------­-----------------------------------------­ Phone.__..............__.._........ _ <br /> Installation will serve: Residence W Apartment House E] Commercial ❑ Trailer Court F Motel 0 Other [3 <br /> Number of living units: A---- Number of bedrooms-3----- Number of baths Lot size ----- ......................... <br /> Water Supply: Public system El Community system X Private Q Depth to Water Table,§'P ft. <br /> Character of soil to a depth of 3 feet: Sand [] Gravel [] SandyLoam 0 Clay Loam 0 Clay El Adobe 0 Hardpan 0 <br /> Previous Application Made: (if yes,date--------------------I No J� New Construction: Yes-0 No D FHANA: Yes 0 No [I <br /> iIII <br /> T OF INSTALLATION AND SPECIFICATIONS; <br /> Ily <br /> (No septic tank or cesspool permitted if public sewer is-available within 200 feet.) <br /> Septic n Distance from nearest --- istancfromi <br /> p well---- .D foundation---e!P�---------Material /------ <br /> No. of compartments-------7----------------- clepth------1/...............Capacity...................... <br /> isposal Field: Distance from nearest,�ven--72!�7------Distance from foundation--Z4�.........Distance to nearest lot fine.. .......... <br /> Number of lines Length of each Width of trench-- -,*------------------- <br /> Type of filter material sw- -of material --------Total length---- ------ <br /> ---------------------- <br /> L <br /> Seepage Pit: Distance to nearest well-----------------------Distance from foundation....................Distance to nearest lot line____.___.._.....{ <br /> 0 <br /> Di <br /> Number of pits......................Lining material---.----- ------------Size: ameter-------- - <br /> ---------- --Depth-----------------_-_---------.-- <br /> Cesspool: Distance from nearest well.................Distance from foundation--------------------Lining material.........__..._..._.___...._...._._._ <br /> El Size: Diameter--------------------------- ----------Depth----------l-----------------------------------------Liquid Capacity............................gals. <br /> Privy: Distance from nearest well_________________-------------------- !-----Distance from nearest building__._.__....__..____._._____.__________... l'' <br /> II ❑ Distance <br /> uilding----------------------------------------- <br /> Distanceto nearest lot line-------------------------------------- --------------------------------------------------------------------------------------------------- <br /> I emodeling and/or repairing (describe):------------------------------------------------I........................................................................................................ <br /> ------------------------------------------------ -------------------------------------------------------------------- ­­I------------------------------------------------------------------------------------------------- <br /> 1P ....... ...................----------------­----------------------------------------------------------------- <br /> --------------------------------------------- .......................................... ------------ .. <br /> - <br /> - --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> II hereby certify that I have prepared this application and that the`work ;�viil'bi�-do`n`e in accordance with San Joaquin County <br /> rdinances State laws, and rules and regulations of the San Joaquin: Local Health District. <br /> IIU <br /> in relation to wells,tuildings, etc., can be placed on reverse side). <br /> A, <br /> fr igned)-­ -----------------------------------I-- --------------------------------------------------.---(Owner and/or Contractor) <br /> T <br /> By------------------------------------------------------1< ---- - --------------------------(Title)-----------­ ------------------------------ -- -------------- <br /> 'let pla showing size of lot, location of Sys em <br /> FOR DEPARTMENT USE ONLY <br /> dp ACCEPTED -------------------- <br /> --------------------- ............ DATE------ll ------------------ <br /> PPLICATION PTED BY.,/..�?�-- - -� <br /> REVIEWEDBY-------------------------------------------------- ------------------------ ---•--.......------------ DATE------------------------------------------------------------ <br /> ­ <br /> 6UILDING PERMIT ISSUED ----------------------------------- ------------------- :�--------------------------------- DATE------------------------------------------------------------- <br /> 'Alterations and/or recommendations:--------------------------------- --------------I--------------------------------------------•.............................---------------------------------- <br /> 111i; <br /> ----------------------------------------- ---------------------------------------------------*----------------------------------------------------------------------------------I-If-------------------*---------------------- ---------- -------------------------------------------------- --------------------------------------- <br /> ------L--------------------------------------------------------------- ---- --------------------------------IIIA..................................I------------------------------------ ---------------------------------------j---------------I------------------------------------- -------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------------:I-------------------------------------------------------------------------------------------------------- <br /> FINAL INSPECTION SYZA.4�011 ­.-�� -----­--------------------- Date---6? <br /> ...... ....... ------------------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street I 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-89 2M a-61 ATLAS <br />