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FOR OF E U5 : f <br /> rr <br /> ----:------- ------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. ..�..���.. <br /> t - - (Complete in Duplicated Dote Issued __7//-...._�.v <br /> ------------ - <br /> - ------- This Permit Expires I Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District r a permit to construct and install the work herein ribed. <br /> This application is made in compliance with County Ordinance No <br /> 1 J08 ADDRESS AND L ATIO s <br /> _-•----8 -7­ �; <br /> ........- ----- <br /> Owner's Name ---__--• ---- -- ° ---- ---- Phone".,o... <br /> Address__. -` t �- <br /> --• ------------- ---•--•-- ... <br /> Contractor's Name-.. --,. Z 14 <br /> _ •__ <br /> . -� ��. t--------- ................. Phone. <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> I <br /> i Number of living units. 1. Number of bedroom!,3__.Number o aths . ... Lot size ------ <br /> i <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Tab e fCl'®ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑- Sandy Loam ❑ Clay Loam ❑ Clay ❑ dobe Hardpan ❑ <br /> t <br /> Previous Application Made: {lf yes,date_--- .-----_----) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION,AND SPECIFICATIONS: a <br /> (No septic.tank-or cesspool pe—rmitted;if pyblic sewer is available within 200 feet.) <br /> l Septic nk: Distance from nearesf'well --------Distance from foundation..-/ f� <br /> a -------------.Material--••--- <br /> k No.-of compartments-_ 9-- -Size _. _�� " °� <br /> '�=r& Liquid del?+h-. c ------- ----Capacity �: .. <br /> �L <br /> Disposal Field: Distance from nearest welLj�,.-,_.D-:stanc 'ftom foundation_"Il" ._.Distance to nearest lot line__-__�...... <br /> Number of lines-----�_ <br /> ----Length of each IineO---"jtf�_' /1/idth of trench.__-,/ - :_________-_ <br />{ , Type of filter`material. _-. -- Depth of filter material-.X-��'�---Total length -�________________•-.--- <br /> � 5eeae l / <br /> p g Distance to nearest well- _�Wkfance from foundation_�.��____.Distance to nearest lot line--------;;�.... <br /> Number of pi ------------Lining material__-QC!k.------Size: Diameter--- ..__,Depth-----'- • <br /> _--------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation <br /> ------------------- material---------------------- <br /> -•-------.--. <br /> 1 ❑ : s . Size: Mametei'--------------------------------------Depth-------------------------------- - <br /> Liquid Capacity_------•------------------gals. <br /> Privy: Distance from nearest well----------------------------`-------- <br /> '-_-_--_--Distance from nearest building <br /> - <br /> ❑ ! Distance to nearest lot line-_----.--.-._---------------------------_.----._ <br /> Remo eling and/' r--repairing (describe)------ --------- ---------- ---_--__-__-....t_----- - JL__-..._... <br /> i ----•-. .----------- <br /> - 4------- --- <br /> - :.�rrt? 7J7 <br /> i <br /> -----------------------------•------------- -------•--- --•-----------•-------•-••--•-----. ---------------- <br /> L-L.- <br /> Al <br /> erecer+' jr,fhatjl have p pared this application an hat the work will be do in accordance with San Joaquin County <br /> ordinances, _s, Fule�-nd r gulations o t e San oaq in Local a Di ict. <br /> (Sighed) <br /> . ---------•••• ----.... -----•--] <br /> r Contract <br /> lB1. y:..........-•------------------- ------------------------------------•------- (Title)- <br /> - ---- - -- <br /> (Plot plan, showing size of to , location of system in relatio wells, buildings, et , can be placed on reverse side). <br /> ------------ <br /> FOR EPA TMENT USE ONLY <br /> APPLICATION ACCEPTED BY - ----- ------- -------------- DATE ��. <br /> ------------ - <br /> REVIEWED BY -------------- ----------------------------------••-----------------•• DATE <br /> ----------------_- <br /> BUILDINGPERMIT ISSUED----------------------------------- --------------------------------••---•• ....--------••---- --•--- DATE <br /> •Alt 'ation an or recommendations:----------------- ------------ ------- <br /> -:_ <br /> 7 • --_---•--------------------- -------------•••------_••---------_-•----_-•_ •------••--__---_.....-__--•-F-•_-----_•-----••-•-_-••-•------•----------- ---- - -- - <br /> 4 <br /> �.... . <br /> --------------------------------------------------------------- ----- _ _ <br /> - --- -•----..._i.7- 'l 't'd-•-._----�' � --."- .............` 1�:. ......... - --------------•.-----..-.--- <br /> ►eva.. ►� -----------------' ` <br /> FINAL INSPECTION BY:.......�i -----------•. --------- Date--- - ;''{° "" <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 20S West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> EB 9 REVIS$D 5-59 @M 5-61 ATLAS <br /> r <br />