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FOR OFFICE USE: �t <br /> �k:- v�--�-- z� �------ APPLICATION FOR SANITATION PERMIT Permit No. ....��3./ <br /> --------------------------------------------------------- (Complete in Duplicate) jy <br /> Date Issued <br /> ---------------- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health Dist <br /> ric ora permit to construct and install the work herein described. <br /> This application is made in compliance with County <br /> Ordinance N 549. <br /> JOB ADDRESS AND N............. _ ._ ! -� <br /> ...........................................................---- <br /> Owner's Name______________ _-- - Pho 7 F�_. <br /> ................. <br /> Owner's <br /> ---------- -- <br /> _ ...!�. . .. . -----•------•----------•----------------------------------- <br /> /Contrac#or's NameCa- -- <br /> Phone. .. ! <br /> Installation will serve: Residence k- Apartment House ❑] Commercial E] Trailer Court ❑ Motel Other El." <br /> Number of living units: i.... Number of bedrooms NCoumber of bath____ Lot size ... __ ....../ <br /> Water Supply: Public-syste 'r Community system ❑ Private ❑ Depth to Water Table ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe&<ardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No, HA/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 /> TTanktic <br /> : �� Distance from nearest well.................Distance from foundation--------------------Material................................................. <br /> ��..f% r� No. of compartments--------------------------Size----------------------------=---°Liquid depth--------------------------Capacity....................... <br /> Isposalfield) Distance from nearest well-Ro�._Distance from foundation-f....4 r.,.....Distance to nearest to line------ <br /> Number of lines_______.-_ _.______ _ _.__-___Length of each line------�__Q---- ____.Width of trenchf �_.l--------•--- <br /> e(- Type of filter material _-- .Depth of filter material___ _�'t-____-Total length___ �R--P---______________________ <br /> Seep a Pit: Distance to nearest well-------------- ------Distance from foundation....................Distance to nearest lot line__.________.___-- <br /> Number of pits----------------------Lining material----------------------.Size: Diameter------------------------Depth-------------------------.------. <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material______________-____________________-_ <br /> ❑ 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)------------------------- -- ------------------- -------------- ---------------------- -- ----------------------------•........................... <br /> ------- <br /> - <br /> ----------- -- ------------------..---------------------- <br /> •------- <br /> •-------- <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 rules and regulations of the San Joaquin Local Health District. <br /> ..(Signed) iit -------------- Contractor <br /> 1�#: TAkNK 9ERVICE <br /> By2lI E:MlnerAvle.,--=.HD..6,3841------------------------------- ---- --. . -- .......�.......(rtle)--------------------------------------------------_.__._.------- <br /> (Piot plan, showing size of lot, location of system in rely i n to wells, building etc., can be placed on reverse side). <br /> FO EPART ENT USE ONLY <br /> APPLICATION ACCEPTED BY- ---- --- - - ---- ` ��u- DATE - Z 'L -------------- <br /> REVIEWED BY =-- ------------------- DATE <br /> - - `- •----.--..._.._..........._. DATE-- ------ ----- --- - --- -....- •- <br /> BUILDING PERMIT ISSUED.._. ------------------------------------------------------ � :............... <br /> Alterations and/or recommenctations:�-- G?. _ ___ �. <br /> a - ----------- ---••---•---•--•----­­•-••--••-•----- ------- --•- ......--------------- <br /> r <br /> R <br /> FINAL INSPECTION BY:__ :_. Date-----..._ __ .. .. <br /> SAN JOAQUIN LOCAL HEALTH DISTRIC <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,callfornta Lodl,California Manteca,California Tracy,California <br /> i E8 9 REVISED B-89 2M 5-61 ATLAS <br />