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FOR OFFIC,EVSE: <br /> y <br /> �47/ _-__ APPLICATION FOR- SANITATION PERMIT Permit No. ....... ..: . <br /> i r <br /> (Complete in Duplicate} <br />--- ----- ------------------------------ - <br /> _ <br /> - --- _ ._____.___ This Permit Ex ires 1 Year From Date Issued Date Issued ..................... <br /> Application is hereby made to the San Joaquin Local Health Dis is for a permit to onstruct and install the work h 'rein described'. -r 4 <br /> This application is made in compliance with County Ord' o. 549. <br /> f ....... •-•.---- ---•------------- <br /> JOB ADDRESS A OCA 10 2..�� -------- ---r------ ------• -•-----`-"'-------- ---------'-._..-•-------------- -- <br /> Owner's Name----- - ------- --•----- Pho � <br /> "� <br /> Address__ <br /> 1 .. �. <br /> Contractor's Name.. ---------•s `0Uy.. --- ---- - -- ----- -- -•--. ----------------------- Phone-A-. <br /> Installation will serve: Residence Apartment House E] Commercial [jTrailer Court [IMotel ❑ Other [Ir � <br /> Number of living units: _..___ -er of bedrooms __? umber of baths /•.• Lot size4P--S---------------- <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table-o ft. <br /> Character of soil to a depth of 3 feet: Sand Gravel Sand Loam ❑ Clay Loam ❑ Clay [],,,Adobe <br /> Hardpan ❑ <br /> C P ❑ ❑ Y <br /> Previous Application Made: (if yes,date---------_----------I No ❑ New Construction: Yes ❑ No 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.) <br /> is T rlk: Distance from nearest well___-_---_______Distance from foundation--------------------Material.------------------------------------------------ <br /> No. of compartments--------------------------Size----------------------------...Liquid depth--------------------------Capacity....................... <br /> Das Distance from nearest well------------------Distance from foundation....................Distance to nearest lot line.....__...--•_--- p <br /> Number of lines----------------------------- --Length of each line------------------------------Width of french----..-.--------.------------------ <br /> Type of filter material______________-____. ___Depth of filter material_____-__......-.__._Total length....................-__________-._.--___-- <br /> Seepage Pit: Distance to nearest well__I ._____Distance om founciation__.��_._.Distanfe to nearest lot line___�_�Q-- �} <br /> Number of its__ Linin material.. 1 --__--Size: Diameter_�.5 ..______.De Depth _ <br /> P g . P •--•-•--- ....- d <br /> Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material------------------------------------- <br /> 0 Size: Diameter------------------ -------------------Depth----------------------------------------------------Liquid Capacity............................gals. <br /> Privy: Distance from nearest well------------------------------------------------- from nearest building_____........__._______________-----_____. <br /> ❑ Distance to nearest lot line----------- --- ---•-----------------------------------------------------•-••--•-- ----------••----. ---- •- '- ---•-----•-------- <br /> Remodeling and/or repairing (describe): ........................ �:,_-A,---•---•--------------- -••---•----••-- <br /> a:�LCillo't' <br /> -- ---- --- j. .� <br /> --• --- -------- -- ••--•----------------.... <br /> -•--------------•• :- ------... <br /> I hereby certify that I have prepared this application and that the work will a done in accordance with San Joaquin County <br /> ordinances, State laws, and rules a d regulations of the San Joaquin Local Health District. <br /> g '� QT &V r <br /> L <br /> (Si reed.. �_�r� ,�..!• ... �+ - - ----- Contractors <br /> By:-------------------------------•-----••----•-------------------._..--------------•----------•-- Title <br /> (Plot plan, showing size. of lot, location of system in relation to w s, building a .,`can be placed an reverse side]. <br /> �7 FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED ----------------•--•---•------------- DATE....... — - ---------•------- <br /> REVIEWED BY--------------------- DATE <br /> BUILDING PERMIT ISSUED f/....- ---------------------- <br /> ------------------------------­ ......:DATE------------------- <br /> r - __ 3 <br /> - -------------------- <br /> ----- <br /> ----• <br /> Alteratio s and/or •••-••---••--••---••-•-•--------pd-- <br /> ...... ---- .......... --------- ------ ----•------------------ --•-- ----....-----......_---------------------------- <br /> � zm <br /> ------------------------- --------- ------- -----------•-•-•- .... -----------------•-----------•---•------------•-------------•-•----•-•------------ -----------•--- •- <br /> FINAL INSPECTION ------ -•--- - ----------- _ Date__...:'.`— ---------- �Z"... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Soret 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California - Tracy,California <br /> i <br />' E6 9 REVISED 6-89 RM 6-61 ATLAS <br /> s <br /> P, <br />