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FOR OFFICE USE: <br /> ,x *a <br /> APPLICATION FOR SANITATION PERMIT Permit No. ...._.._.............. <br /> --------------------------------------------------------- (Complete in Duplicate) <br /> --------- -------------- This Permit Expires 1 Year From Date Issued fDQate Issued 1-�?-.~!J___.. Z- <br /> Application is hereby made to the San Joaquin Local Health District for a ermit to construct end instal l fihs work�reeiin—_ 0 <br /> crbed. <br /> This application is made in compliance with County Ordinance No. 549.,:_/70_2 E <br /> JOB ADDRESS A LOCATION_._ <br /> Owner's Name _ ----- Phone.----------•---------------- <br /> Add ress-------------- <br /> --�J-�, <br /> Contractor's Name........' J -------------------------------------------------------------------------------------- Phone.---......-----------------------• <br /> Installation will serve:`Residence Apartment House E] Commercial Ll Trailer Court E] Motel [3 Other E] O <br /> Number of living•u`nits: _. _8 Number of bedrooms ._ Number of baths ..,1__ Lot size __ <br /> -•........... <br /> Water Supply: Public system D Co munity system ❑ Private Depth To Water Table .flJ7 . <br /> Character of soil to a depth of 3 feet:" Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam gj­Clay ❑ Adobe❑ Hardpan ❑ i <br /> L. Previous Application Made: (If yes,dote--- ---------) No 5R' New Construction.- Yes ❑ No gr FHA/VA: Yes ❑ No [�]--► <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public,sewer is available within 200 feet.) i <br /> Septic Tank: Distance from nearest well---,<1,0_-Distan //prom foundation----0/e.-.Material___�__4 , f7/ ------- <br /> ,No.-of-.compartments-----/- Size_ - ---------_-----_-- -•---Liquid depth__. - Ca aci <br /> p ty-.4- dO---- <br /> Disposal Field: Distance from nearest 11--IA®_�_Dis#ance from foundati n___ 0:�-.-..Distance to nearest log line_,E,Fa.�__-__. <br /> Number of lines._____.... .T�� _------ Length o`f'each Iine_���, s� Width of trench &:7,-"a� _______________________ <br /> Type of filter material._,l%_--- Depth of 'filter material__��__-.-----_Total length---�!Q�___ ------------------ <br /> 1 <br /> Seepage Pit: Dist�nce,fio nearestv�well__ ___Distance fr f�ou�anon:___�`� ____.Di `ce to nearest lot line.�1 <br /> mr Number of pits----4 �---_______--_Lining material___ 474ir's.Size: Diameter_ -----_--.- <br /> .,• !,;. --Depth-- ------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------�'".Lining material----------..__.------------ <br /> ., .---..,..--. -7—'� - N--- <br /> ❑ Size: Diameter ,terDepth ------------------------------------------;Liquid",Ca acigals. <br /> Privy: Distance from nearest well_______________________ pis#ante,from nearest bu'Idin <br /> -------------- <br /> w ------------------------------------------ <br /> Distance to nearest lot line-------------- --------------------------- ------------ � ...-----�-�..-,l`------ •-•-- <br /> Remadeiin ander repairing {d scribe}:_ } <br /> V, jj,- <br /> ----------------- --------------------- -----•-- ; <br /> -----------•---------------= --•--------- --------- <br /> I hereby certify that I have prepared this application and that the work will be done in act fiance with Sang Joaquin County <br /> ordinances, State laws, and rules and.re ulations=of the San Joaquin Local Health'District. '�+ '4 ; <br /> f `� I i Hrwn <br /> ,�,• Ll/ , <br /> (Signed) {�-- -_ ontractor] <br /> By-------------------_---- <br /> ---- -------------- - <br /> (Plot plan, showing size of lot, location- of system i lation to wells, buildings, etc., can:be played 'on�rever"seeside]..% <br /> r , <br /> # FOR DEPARTMENT USE ONLY�`..,,- ' l 4 <br /> -- , <br /> APPLICATION ACCEPTED BY------ _--`--- --------------- - -_ - '" <br /> REVIEWED BY <br /> ------- ----- -- ---------------------------------------------------------------------------- -DATE--; <br /> ---------------•-------------- <br /> . UILDlNG PERMIT ISSUEb------------------------• •-----------------------------------------------------•--------------------- DAME-=----------------------------------------------------------- <br /> /_jAlterations and/ar r tom endations:._____..__._ <br /> --- -- - ------------- <br /> / _.`� <br /> -- --- -t- <L �. _ --•------------•---. <br /> ------------------------------------------- <br /> -____________________________________________________ <br /> I <br /> FINAL INSPECTION BY: - ------ Date---- <br /> SAN J&Qb N EOC L'`HEALTH= DISTRICT <br /> 130 South American Street 300 west Oak Street 124 Sycamore street 205 West 91h Srr••r <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> 5�9 REVISED 8-59 ZM 5.62 ATLAS r <br />