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FOR OFFICE USE: <br />------------------------------------------- ------- - , <br />----------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date issued <br />--------------------------------------------------------- This Permit Expires 1 Year From 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 /> 11hV �.�t� is made in compliance with County Ordinance No. 549. <br /> This <br /> 3 <br /> O AND OC TION_ l- �/ f`� ----- ' 'Lam...- ®" -•---- <br /> Owner's Name ---- --------- Phone.,-�._.. <br /> tc --------* <br /> 1 6_22511 <br /> Contractor's Name_- .. _..cif ar ---- r Phonet� " <br /> d... �: ....__ U----- - <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> a�-- Number of baths ./�,Lot size .. -�......•=x.----••�''�--`' <br /> Number of living units: _�•_ Number of bedrooms . , <br /> Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel Sandy L_ oam ❑ Clay Lo�__a_m ❑ Clay [3 Adobe Hardpan F] <br /> Previous Application Made: (If yes,date--------------- No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No E] li <br /> TYP F INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> tic€ :t Distance from nearesf.well_________________Distance from foundation---. .'"""RMateri8l____-...________..._...__.....:...!__.:.......__. <br /> ' ----Capacity -- ! <br /> No. of compartments--------•-----------------Size---------....------------------.Liquid depth--•-•--------•- - ••----._..._--__...--.. <br /> os bd: Distance from nearest wel $_�_�._.Distance from foundation_ iQ-"....Distance to nearest lot line.. €.. ...... <br /> �J Number of lines- "_�___ ; _____. .-____ Length of each line--;--- --.Width of trench.__ _ *--'.---_.---- <br /> ,,'T J��1 Type of filter materia______ _ _Depth of filter ma erial._, -_T.__Total length....... <br /> } /'---Distance- t r <br />' <br /> Se <br /> a Pit: Distance to nearest well _ __ from foundation_ _____Dlstnn.e to nearest Iot lie.... y <br /> Number of pits.---- -•---...__--Lining material---- 3Q -----Size: Diameter---rs... .--!-----•Depth...-_L -f'�.--- -•.--•--- <br /> Cesspool: Distance from nearest well-----------------Distance from'foundation----_______________lining 'material--------- ' Y <br /> t <br /> P -li Y --------•-Liquid <br /> ❑ Size: Diameter De Depth - Capacity.. gals. <br /> I Privy: Distance from nearest Distance tib nea est lot lime-__+_.____._____ Distance from nearest•budding________________�__._____.__...___ <br /> ------ <br /> ❑ ----------- ------------------------- --------•---- <br /> Retnodeiing and/or repairing (describe): <br /> i �. - =f ....----- - -- ' I <br /> •------•----•- ------.---- ------------- <br /> ----------------------------------------------- <br /> - - --..-----I - <br /> •--------------------------------•-------------••--•--=----------------•---- <br /> hereby certify that I have prepared this.application-and that'the work ill be done in accordance with San Joaquin County <br /> ordinances, State laws, nd runes and regulations of.the SanJo, aquin Local Health District. i <br /> 1 _t�i i-----C....----------- --------------------------------- Contractor) <br /> (Signed)-- �2 Q <br /> r�/ ---------(riifle)....... ------------------------ <br /> By:---------------_-----_-_-- -------------------------------- ------------ ... <br /> (Plot plan, showing size of lot, location of system in-rel4n to wells, buildi s, etc., can be placed on reverse side).' <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY----------------------------------------------------------------------- --------------•------•---- DATE-------------------------- --------- -------------------- <br /> REVIEWEDBY--------------------------------------------------- --------------------------------- -----------------•-----------•-•-- DATE-----------------------------------------•------------------ <br /> BUILDING PERMIT ISSUED---------------- ------------------------ -------------------___--------------------- <br /> ------------ DATE.-------------------------_----------------------•---------- <br /> IAlterations and/or recommendations:------------------------------------------ -------------------------------------------'------....................--------------------------------------.... <br /> ...............................---------­------------­- -. ------------------------ ---------------------- --------------------.... <br /> IL <br /> ---------------------------- --------------------------------------------------------------------------------•---------------------------------------------------..........--••-------------- <br /> f - ------------------•-------------------------...---_--------------------•-------------------------------•-•--.....------. <br /> ..- .----------- ------------------------------------- <br /> •---------------- <br /> .................................... ----------••--••------ ------ <br /> -- ---- <br /> ---------------------------------- <br /> FINAL INSPECTION BY:. Date_ <br /> SAN <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9Th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-89 ZM 8-61 ATLAS <br />