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rV rrl u :/ -- (J #(6 <br /> __________________________________________ , APPLICATION FOR SANITATION PERMIT Permit No. ....._'T_____.____ . <br /> ------- -------------- -i---- (Complete in Duplicate) Z <br /> - This' Permit Expires 1 Year From Date Issued 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 /> This application is made in compliance/with County Ordinance 5 9. <br /> JOB ADDRESS ANWL <br /> ATION---1-_�,'Z_,Z-...... �,/�� <br /> 1`7 <br /> Owner's Name e (,-0— <br /> . �.. c , _ Phone..................- <br /> J - r <br /> Address. ------------ ----------- �- _ �*1 �' .. <br /> Contractor's Name----------------- / p Phone <br /> Installation will serve: Residence ga-lApartment House ❑ Commercial ❑ Trailer Court ❑//Motyl ❑ Other ❑ <br /> Number of living units: __ ___ mber of bedrooms . Number of baths ../-. Lot size -_fP- 4k_1_�V-�---,�./Q-........ <br /> i <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table�Qft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2--gardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No E13--* New Construction: Yes ❑ No Mo***FHA/VA: Yes ❑ No g?' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> /' <br /> SFlptic Tank: - � Distance from nearest we ______.._... Distance/�aLm foundation----�0---------Matef,rial__�.� _ ..................... <br /> ' No. of comp tments______ .. _` .._Size_ 62__,/ &*__,...Liquid depth__�J_G__P,�.-_-___.___Capacity. 4.114.0..... <br /> Disposal Field: Distance from nearest well.____-- .....Distance from foundation-.-.� __-____Distance to nearest lot line.-O.. <br /> - -- <br /> i Number of lines--------- iY_.- length of each line__ �fp f trench._,Z, -----------------________ <br /> Type of filter material epth of filter material . ... t_______-_Total length_._. __�-_---_•__________________ <br /> Seepage'Pit: Distance to nearest well______-� --------Distance frQm foundation__/&*___.__-_-.Dis a ce to nearest lot line:.__..____ V <br /> Number of pits__..:e_____________Lining material__ -Size: Diameter.119--__-__-__..Depth��/..............I... V <br /> Cesspool:, Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- <br /> L] Size: Diameter----- ,-----------------------------Depth----------•-----------------------------------------Liquid Capacity---------------------------- <br /> Privy: Distance from nearest well----------------------------------------- -------Distance from nearest building-------....-.___-_______-----._-----___.-. \`\ <br /> ❑ Distance to nearest lot line----------------------------------------------------------------------------------------------------------••-•-----------------------•.--•--- <br /> ll <br /> Remodel incj'and/or repairing (di3scrihe) - -------- 1 .._..- <br /> ------- ---------—------------------•---•-----------•--------•-•--------•----..._.....------------------------------- <br /> -------------­--------- ---------------------------------- <br /> --------•-------•-----------------,...----•--------••---------------- -------------------------­- ---------•----------------------------------------:............---------------------------------------------------- •----- <br /> t <br /> I ,hereby ibi-fifythat I have'pre-paredithis applieatlon and that 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)------------------ <br /> - ----�_- �------ ---------- ----- ---�-- <br /> -------- --- --- ---------------------------------------- Contractor) <br /> `' (Title) ---- <br /> (Plot plan, showing size of lot, location of system i elation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED 6 ` f <br /> - --- --=------- - -- ----sRr-�:: --------------------- DATE_..,.--°".-,2--�---r.// <br /> REVIEWED BY X <br /> ----- DATE.. -•--------------- <br /> BUILDING PERMIT ISSUED ------------------------ ---------------------- DATE. <br /> --- -- <br /> Alterations and/or recommend'ations:.� .2-/a.t-(o--t.,.------ _, _ •- --`_- -- �� <br /> -•-- -- � <br /> --------------------------------- - ------ <br /> FINAL INSPECTION ,h- --- -------- Date----±------ <br /> _ •= <br /> f SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wool Oak Street, : 124 Sycamore Street 205 West 9th Street <br /> �! Stockton,California Lodl,California Manleta�'Cailfornia Tracy,California ]t <br /> ED 9 REVISED S•99 ZM 6.61 ATLAS J <br />