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FOR �C SE- <br /> 7 <br /> E: / z <br /> 1 <br /> _____ _____ ______ _______ --____._.. 'r <br /> ✓ � --------��i-__l� ICATION'`�OR SANITATION PERMIT Permit No. <br /> 3 <br /> I -------------------- - - --- -�� - f l (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 construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> 2� e✓tJ- ��s �C_-te4--u�- - ` 9 <br /> JOB ADDRESS AND O�CAThON - � lrrlt-._, "?-JpC ----- ----••------------------ ---------------------- <br /> l �% _ _ <br /> .. --- -------•---------------------------- <br /> Owner's Name. Phone <br /> Address------- <br /> Contractor's Name_____-_--__ ... _ <br /> -�•-�-� •--•------------------•---------------••-----------.....__ ----------- Phone-------•---• <br /> Installation will serve: Residence ❑ Apartment House 27<omrnercial Trailer Court <br /> ❑ .❑ Motel ❑ Other ❑ � , <br /> Number of living units: _ Number of bedrooms Number of baths,__��___-_ Lot size -.1112- _____............. <br /> Water Supply: Public system Community system ❑ Private ❑ Depth To Water Table 9,0 It. <br /> Character of soil to a depth of 3 feet: Sand E] 'Gravel ❑ Sandy Loam E] Clay Loam ❑ Clay ElAdobe ardpan ❑ <br /> i Previous Application Made: (If yes,dote---------- <br /> --------__) No [ New Construction; Yes 9?'-No ❑ FHA/VA: Yes lam"No ❑ <br /> TYPE 'OF INSTALLATION AND SPECIFICATIONS: - <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well ___- ------Distance Distance from foundation____ , __/....Mate rial__ <br /> a <br /> No. of compartments._-, ------------•--Sizev07X"__�.fVG1'(iquid depth------•I-----------------Capacity./ _QQ----- <br /> Disposal Field: Distance from nearest well_�-- --------Distance from foundation_ ----Distance to nearest lotline., <br /> � � <br /> �----•- ma, .._____.. <br /> qr_� Number of lines------- ____ ___________.-_Length of each line---4,5 re___10,_-______.._-__.Width of trench. <br /> i. --;r•------•-------•--- <br /> Type of filter-material,� _Depth of filter material___l�__________Total length_..4Pk7_------------•_ .. <br /> Seepage Pit: Distance to nearest well------ ---------Distance f;pm foundation_...1 .._.__.Distance to nearest lot line_.. .. <br /> p �r_______.__Lining material.______U..��__.Size: Diameter----- Fr <br /> Number of its._.-- -- -- -' -------..Depth---���-------------------i <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material.______------------------------------ <br /> ------------------------------- <br /> ----------------•-----------�. <br /> ❑ Size: Diameter Depth--. ---------- ----Li uid Ca Capacity-- ------- q P tY-'-•--------------------•--gals. <br /> Privy: Distance from nearest well____________________________________ _______Distance from nearest building <br /> ❑ Distance to nearest lot line------------------------•----'----------•------- <br /> �I <br /> --------------•-••-'--------------- -'------------- <br /> Remodeling and/or repairing (describe)__________ _ <br /> ------------------------------------------------------------------------------------------------ ------------------------------------------------------------------- ..............4 <br /> --------------------•------•-------•-----••--•-----------------•-- ) <br /> ::.: --- ----- ----- - ----- •- --•--- -- ----------------- -- •-- ------ - -------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Ceunfy <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> t' <br /> (Signed)---------- / ---- -------------- Contractor) <br /> By------------------------------------------------------- --- (Title).. <br /> of plan. showing size of lot, location of sys+e n relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------ ` <br /> REVIEWEDBY---------------------------------------- --------------.---------------------------------------------------------- DATE----------- <br /> BUILDING PERMIT ISSUED__________...._ DAT <br /> AFFeraiions and/or recommendations:_.---/ - aJ __ /d_. � <br /> - - <br /> y-------�------- - _ _e............. ..... <br /> ---- -- ---------- <br /> � -------- ---- <br /> __.-----•---•--- ------------' - -:. <br /> --- -- ------ ------ ------ --- --- ------------1 <br /> ------- --- ........ ---------- -- <br /> FINAL INSPECTION BY:.._.._. --•.- __ <br /> Date--- - _ ... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street <br /> 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California <br /> Tracy,California <br /> F ES 9 REVISED 8-59 2M 5-6Z ATLAS <br />