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FOR OFFIC U E: <br /> _ <br /> APPLICATION .FOR SANITATION PERMIT Permit No. ....�..__._..-.--1 <br /> --------------------- ---- (Complete in Duplicate) i//fes <br /> -- Date Issued ----------- --�Z -- <br /> ____________________ _ ---._--------------- This Permit Expires 1 Year From Date Issued i �' <br /> F <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��L•�OOC''ATION ..... t%_._..��! lf�► ------------------------..................--------------------------- <br /> Owner's Name.............W � 2!flL!t---.-- (/ - Phone...............--------- <br /> Address---------1-0.-© 5-•----- .. c•----------------------------------------------------------------------------------------------------------------------- <br /> Contractor's Nam?... -----------------------------------------------•-------••-----------••--------------------- Phone............................ <br /> Installation will serve: Residence.,®---Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> L Number of living units: __l'_ Number-of-1edrooms,-�__ Number of baths Z.. Lot size ................................... <br /> Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table ,left. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 21­1�`ardpan ❑ <br /> Previous Application Made: (If yes,date-------__------ ____) No New Construction: Yes ErNo ❑ FHA/VA: Yes ga-' 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 from foundation...,/-_---__.Ma eri�i_.L°_�� � -_-__•--_--. <br /> 4 No. of compartments_____; ______ _Size 69 X--- Liquid de th--.._!�',.'.! Capacity.... p��..... <br /> Disposal Field: Distance from nearest ell-___ _____Distance from foundation__._/.. .1.....Distance to nearest lot line..,-E......... <br /> ❑� Number of lines------ _#_'_�_�__p____.____ Length of each line._.1`l_e_______________Width of french Z." ...____...------------ <br /> ; X9 <br /> ....__..__. <br /> Type of filter materially/a Q .Depth of filter maferial____ _.____.Total length____-_ -_�_____________________ <br /> Seepage Pit: Distance to nearest well-,_______________ Distance from foundation__._�p_�__..Distance to nearest lot iirre� rJ.._.. <br /> --- <br /> [ Number of pits...Z_•-•?_ti,-----Lining material.lep..G __-.-Size: Diamefer__,_,:.F .............Depth_.. ........_............ <br /> � Cesspool: Distance from nearesf.w _. <br /> all.................Distance from foundation._._________...._. Lining material..................................... <br /> ID Size: Diameter---------- ---------------------Depth---------------------------------------------------_Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest-well_________________________________________ ____Distance from nearest building------------------------------------------ <br /> ❑ Distance to nearest lot line----------------------------------------------------------------------- --- \` <br /> Remodeling and/or re airin describe :---- <br /> r ------------------------------------------•---=----------------•-----------------------------------------------------------------------------------------------------•----•-------••-•-...--..--------•--------•--.----------- <br /> ------------------•-•••• -------•-•--------------•----•-•--•----------•--•--------------­----------••---•----•------•---------•-------------------------------------------------- _ <br /> I hereby certify that I'have prepared this application and that the work will be done in accordance with San Joaquin.,,,�ounty <br /> ordinances, State laws, andrules and regulations of the San Joaquin Local Health District. <br /> (Signed)-----------------c O der Contractor} <br /> By:-----------------------------=------------------------------------ -••• �.2'..J--------------------(Title)- �1&__--'------------- ------ <br /> -------------------- <br /> ---- - <br /> (Plot plan, showing size,of lot, location of syst n relation to wells, buildings, etc., can be placed on reverse side). <br /> EOR-DEPARTMENT USE'ONLY " <br /> APPLICATION ACCEPTED: - <br /> BY---j,-- -- ---- - -�"-------------------------------------------------------- DATE----/-L- ��� �` /------------------------- <br /> G REVIEWED BY----------------------;-- ��w- � �w—:----' ------ DATE......•.__....------......----------•-.....--------•---.... <br /> BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE-------------------------------••--------------------------- <br /> R Alterations and/or recommend'ati n ..---------- --------------------------------------------------- <br /> -.......... <br /> .IF r.. .� »......._.. <br /> -------------------------------------------------------- -------- •------- ..................................•__.-........................-.---------•-----------------•-•---------------._.. <br /> } ....................................................................-__---_-.--_----.--__--__-•-_-.----.______.-____-..______-_-----__-____-_-.--.-_____-.-------_---__-_--_-_____----.__._--------•--•---..._.-..__._._._ <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> FINAL INSPECTION BY:___.)e.... .. �M , <br /> --•----•----------- Date. <br /> SAOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street - i� , .300:Wect Oak STree1 124 Sycamore Street 205 West 91h Street <br /> fs <br /> Stockton,California - Lodi,California Manteca,Celffornia Tracy,California <br /> E6 9 REVISE* 6-89 HM 6-61 ATLAS ' <br /> r <br />