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FOR OFFICEjU - <br /> �.�r jr <br /> 0..--- - .- .- ----- % ------ — APPLICATION FOR SANITATION PERMIT Perini+ No. ../S.— <br /> ------------------------- - --------------------------- (Complete in Duplicate) f�2 <br /> ------ --- This Permit Expires ll 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 Ord' e No. 549. <br /> JOB ADDRESS AND LOCATION-•---- ---1-/ y A -----------•--•-------•----------------•-- <br /> VK <br /> Owner's Name---------- •---------------- -- ------------------------ ------•- -- -------- ° Phone.................... <br /> Address............... <br /> 3 z.. ......2+F_ - s <br /> Contractor's Name--------_--- "° -----------------••-------------•----- ----------------------------------- Phone................................... <br /> Installation will serve: Residence g3 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -1----- Number of bedrooms ---3. Number of baths .X_ Lot size .____J1V._K1.�L0 ............................ <br /> Water Supply: Public system Qfommunity system ❑ Private ❑ Depth To Water Table _6q ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 6�Hardpan ❑ <br /> Previous Application Made: llf yes,date--------------------l No New Construction: Yes 2---No ❑ FHA/VA: Yes ❑ No 2 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well..-'-----Distance from foundation._./Q_r_____-.Material____, • _.----••-_. <br /> No. of compartments _____________Size__-•_-_ <br /> p �- �_�_�:X-_Liquid depth-------�---------------Capacity---•- :c?P.-9Put�� <br /> Disposal Field: Distance from nearest well...'"--_.._Distance from foundation__/0..__.._..._Distance to nearest lot line___Is'-".... • <br /> Number of lines_...._.-- _ _.__-__Length of each line___`__-__________--Width of trench__Zy.*_---•-------------- oG <br /> Type of filter material._'7a4_k-------Depth of filter material_/8:_--'---_----___Total length---/0770_________________________ <br /> �f <br /> Seepag it: Distance to nearest well________ ___________Distant m foundation7Q__r......__..Distance to nearest to line________-__--- <br /> Number of pits-----:2-----------Lining materia__ _____. Size: Diameter _ ._.Depth----�.------------------_-- <br /> Cesspool: <br /> r--------------Cesspool: Distance from nearest well----------------_Distance from foundation___ ----------------Lining material.._------------------._---_________-_ <br /> ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well_________________________________________ __._._Distance from nearest building_______________•_-_-_____________.____-... <br /> ❑ Distance to nearest loft line------------------------------------------------------- <br /> Remodelingand/or repairing (describe):-------------------------------------------------------------------.................... ---•-------------------------•---•-----•----------------------- <br /> --•---•-----•--------------------------•-•--------------------••-----------•------------------•---------------------•---•--------------------•.---•-----------------------•-------•---•--------------------•------------------ <br /> ---------------------------------------------•---------------------------------------------•---•--------------- ------------------•----------------------------------------------------- ----••----------------------- <br /> 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations o e S Joaquin ocal Health District. <br /> (Signed)-------------------------------------------------------------- ---- --- - -- ------------------------------------------------------------(Owner and/or Contractor) <br /> By: ---_---------------- <br /> --------------------------------- ---- ---------------- - -----------------------------------------(Title)---------------------------------------------- -- -------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- ''�''. ----------------------------------------- - -/ <br /> DATE. �-y--- -----------------�-: <br /> REVIEWED BY--------------------------------- .- --------- <br /> . ._ -------------- DATE--------------------- <br /> - ------ ----- --------------- -- -- ------ -----------------------•--- ----------------•---....------- <br /> BUILDING PERMIT ISSUED - - ._.---- DATE <br /> Alterations and/or recommendations:_ ------------- <br /> _ __. _._a _�___ •--- --- _ •• <br /> ----------------------------------------------------------------­--------- -- <br /> --------- -------------------------------------------­------ <br /> ------------------------------------I------------------------------------------- ------------------ ------------------------------------------- --------------------------------------------------------------------------- <br /> ----------­---------------- ---- ......... -------------------------------------- -------------- ------ -------------------I------- -------------------------------- -------------------------------------------------- <br /> ------------------------------------------ ------- <br /> ---------•---------- - ---- --------------- ------------• ---------__------------------------------------- •------------------------------------------------- <br /> FINAL INSPECTION Y:._ .-.---- --- -- <br /> Date-- ------------- --- <br /> SAN J QUIN CAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 144 Sycamore street 205 west 9th street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED a-59 2M 5-62 ATLAS <br />