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.vi r:,V t349 <br /> - r <br /> APPLICATION FOR SANITATION PERMIT Permit No. ..... <br /> /� <br /> ------- ----- --- -----' ---- --" (Complete in Duplicate) <br /> This Permit Ex fres 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local H Date Issued _.... 3 <br /> This application is made in compliance with County OrdinanceDtNocS4gr a permit to construct and install the work herein described. <br /> JOB ADDRESS AND L CATI N- /J <br /> Owner's Name.__ l•_ <br /> - - ------------•- <br /> -------------............ <br /> Address--------- Phone <br /> ............-----••--- + <br /> ----- ------ <br /> ----•-------- -----•-----••---------------- ------•------••-----------­--------- <br /> Contractor's Name__________ _ _ _ — <br /> Installation will serve: Residence ... Phone............................... <br /> I��artment House ❑ Commerciale ❑ Treiler,Court <br /> Number of living units: __ -_ Number of bedrooms ❑ Motel ❑ Other [] <br /> Water Supply: Publics stem Number of baths __. <br /> Lot size .,e✓ rf.:d.--...---•-••---•----• i <br /> Y ❑ Communit system Y Y ❑ Private Cpepth TO Water Table._�?� , <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel ❑ Sandy Loam <br /> Previous Application Made: (if yes,date.-__._ .- E] Clay Loam E] CIaZY El Adobe Hardpan C]TYPE OF INSTALLATION AND SPECIFICATIONS ) No: �-New Construction. Yes gi- No ❑ FHA/VA: Yes ®!No ❑ <br /> {No septic tank or cesspool permitted if public sewer is available within 2DO feet.). <br /> Septic Tank: Distance from nearest well___- _Distance from foundation.- e" 1 <br /> No, of compartments__-__. -_-_ tt t------.Mater' l___�i ` fi� <br /> Size��__X• Q_---•----Liquid depth__.__ �f --•.__.. <br /> Disposal Field: Distance from nearest waif.__ _ ___ -_ Capacity._r.QCJ--_ <br /> Distance from foundati n... / "i <br /> Number of lines__.:_:-.�---_--_--_ Length of each line-__ ---_ Distance to nearest I� i?11e- ------------- � <br /> r <br /> Type of filter material f� `L '�- --------------Width of trench_.'_•,----------------------------- <br /> Seepage <br /> -•-------f- <br /> �/ w-Depth of filter materiaL__,�� lengthJ <br /> �r <br /> See a e Pit: Total __- <br /> p 9 Dis#ante to nearest well --- <br /> from foundation__- _ a <br /> ��s ���-------.D"stre to nearest lotLl•ne--r `-�-_-- <br /> Number of pits _______ ____Lining material-- - <br /> -----__.__.Size: Diameter- <br /> ---------- <br /> Distance from nearest well-----------------Distance from ,foundation____----------_- Linin +V <br /> N. \ <br /> ❑. Size: Diameter. g material_. --•---------- •---- --- -- <br /> ------- --- ----'- ------•-Depth------'-----------------------------'-'-------------Liquic! Capacity---------I------------------5als. <br /> Privy: Distance from nearest well__'--------------- <br /> Distance from nearest building--_------•--------- <br /> ❑ Distance to nearest'lot line___.____-___ t j <br /> -•-------- '� <br /> Remodeling and/or repairing (describe)------------------------- <br /> .............................................-------•-----••------------------- ----- <br /> -- <br /> ------------------- <br /> - -eb -- ------•--\ --•--- --------------------------•---------- -----------------------------------•-----------------------•--•------------ <br /> i <br /> I hereby certify }hat I have prepared-#his-application and fhat the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)_---_ C. <br /> __• ` <br /> --------------- r <br /> ---------------------------- Contractor) <br /> By:-----•-------------•--_- --- ------------- - v 9 , <br /> (Plot plan, showing size of lot, location syste relation to wells, buildings, etc., can bel plated an reverse side). <br /> ----- •-- ---I ) t.1r�Gr----------------- -------------------- <br /> Of <br /> ­FOR=DEP AT !: T <br /> APPLICATION ACCEPTED BY_.._._.. _ _ <br /> REVIEWED BY - DATE-----'' G <br /> BUILDING PERMIT ISSUED......------•--------------- ------ -- -------- --'----- -------•----------- <br /> -------------•------- ----- DATE-- ------------------------------------••-------•---------- <br /> -------•---------------------------------�-------•----------------------------- - <br /> AFFera ions d/or recommendations: <br /> DATE-------------------•--- -•------------------------•---------- <br /> ---%�,%$- - -. <br /> ----------------------••------•----- <br /> --------- <br /> - --------- -- ----- ----4- - - ---------------------------------------**------------------------*------------------ <br /> FINAL INSPECTION BY <br /> ,(, Date---- <br /> i SAN JOAQUIN LOCAL HEALTH,DISTRICT <br /> 130 South American Street 300 West Oak Streit <br /> Stockton,California 124 Sycam�rstreet r i ,`.# 205 Wesf'91h Sfise't' <br /> Lodi,California �„ Manteeb;'CgRfoPnla' <br /> ES 9 REVISED 8.59 2M 5-62 ATLAS { ""�^--�' Ticity, olifornia <br />