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!FWKvrrit,C UDC.. <br /> ---- -------- --- _ . ------------ APPLICATION FOR SANITATION PERMIT Permit No. .��.�..�_Q <br /> ------ (Complete in Duplicate) <br /> JI <br /> ------------ This permit Ex fres 1 Year From Date Issued Date Issued <br /> Application is he�eby 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 Coun Ord' anc No. 549. <br /> is <br /> JOB ADDRESS AND LOCATION-_-' (•��-•- : - --`-_-•_---- <br /> - -------------------••------ ---------•--------••---..................... <br /> Owner's Name = ----------- -------- Phone..................................... <br /> r Address ................ <br /> Contractor's Name___-- <br /> ---•--------------•-•------------------------•-------------------------- -----= <br /> t -� <br /> .................------------------------------- ---•-----------------•-•----•------------------ .............. Phone------------------------------------ <br /> Installation will server :Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [] <br /> Number of living units: --,Z-- Number of bedrooms ---- Number of baths ... Lot size __ p- _� .Q'-----•--...-•______.......... <br /> Water Su Public s stem "j` - "�" '�` <br /> pply: y a Community system ❑ Private❑" Depth`to lNafe�Table 1.0 ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan <br /> Previous Application Made: (If yes,date---------------------) No g3'- New Construction: Yes �o ❑ FHA/VA: Yes ❑ No 92' <br /> TYPE <br /> 2'TYPE OF INSTALLATIONANDSPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septi Distance from nearest well-----------------Distance from foundation__-_---_-----_---.Material,..__-------_•--_---__-----------•---._.......-_. <br /> No.'.of'compartments--------------------------Size--------------•-------------_-Liquid depth------- Capacity P ty....................... <br /> Dispo a Fief Distance from nearest well-----------------Distance from foundation___--...._-----•....Distance to nearest lot line................. <br /> Number of lines-----------------------------------Length of each line------------------------------Width of trench------------------------­----- <br /> Type <br /> ----------------__------_ •-Type of filter material-------------------------Depth of filter material-----------------------Total length............................ <br /> .•-----_-_--- <br /> See pag�Pit: - Distance to nearest well r / <br /> HT1 ---._.Distance from fou dation__-��.____-._-_.Distance to nearest lot line__..-._--__ <br /> Number of pits------ -------------Lining material -Size: Diameter------3C-- .....Depth-_.-..-_?zS7_-__•-•-•--- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------ <br /> ElSize:;Diameter---- =------------------------------_-Depth.---------------•---------•----- <br /> Liquid Capacity -------------gals. a <br /> Privy: Distance from nearest well---------------------------------------_--------Distance from nearest building_---_=_.: <br /> ❑ Distance to nearest lot line <br /> Remodeling and/or repairing (describe)------------------------------------------------------.------------_- <br /> a -------------------------------------•------•--------------•--•-.--..-...----------•--------------------------•-----•-•------.---•- <br /> -----------•------------------•------•------... <br /> --•------------------------------------------ i <br /> I 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 an re /lationsthe San Joaquin Local Health District. <br /> (Signed)---------------------_------------>--- ----• -- --------- -------------------------- -------------------------------(Owner and/or Contractor) <br /> ---------- <br /> By:-----•-------------•----•--- -ion - - -------------------------- • -•-----------------------•...(T'ifle)----------------------------------......... - -- -------------- <br /> (Plot plan, showing size o of, I 'cation of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED ICY---- r ---------------- --------- ------------------------------------------- DATE_.- <br /> REVIEWED BY ---- ---------=- DATE <br /> -------------------------------- <br /> BUILDING PERMIT ISSUED------•-----•------------------------------------------------------------------------•--•-------------- DA-TE <br /> Alterations and/or recommendations: <br /> .--- rec-rommenda•tions---'--.-.-------^----- - <br /> ---e ,... -- ----- <br /> --------------------- .. <br /> !!'w------..r� - .f...........................»..---.._------ <br /> - <br /> -------------------------------------------------------•----- ------------ ------------------------------v-"F - r <br /> '-- " <br /> -------------------------- • ------ <br /> FINAL INSPECTION BY: ..' d _ Dete--IL. I G <br /> ( SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> f <br /> 130 South American Street 300 West Oak Svreet' 1-24 Sycamore Street 205 West 9th Street y <br /> Stockton,California Lodi,California Manteca,California <br /> Tracy,California <br /> ES 9 REVISED 6.69 8M 851 ATLAS <br />