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FUR OF <br /> SE: <br /> r� ------------- <br /> ___________ ---------_---_----__----------- ----- APPLICATION- FOR SANITATION PERMIT Permit No. <br /> --- -------------------------- (Complete in Duplicate) <br /> -------- This Permit Expires 1 Year From Date Issued Date Issued ..... _...f®...�— <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 No. 549. <br /> JOB ADDRESS AND LOCATION----- ____ ..__ _ _______ __� z �. .-------------------- <br /> ------------------------------ <br /> Phone <br /> ...........Name------------ --- L <br /> Address -----•----- ----•----•--------- <br /> - <br /> �. <br /> a <br /> ----•-------...-----------------------••--••------------ <br /> Con#rector's Name ------------------- -------------------------------------•-•- Phone <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [,ip �. . <br /> Number of living units: __f_. Number of bedrooms .._Number of baths ..�___- Lot size -------------------P__' _.___r-r-,. - -:. <br /> Water Supply: Public system ❑ Community system ❑ Private [Z Depth To Water Table - f#. <br /> Character of soil to a depth of 3 feet: Sand.❑ Gravel ❑ Sandy Loam W Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (if yes,date---------------- ---) No10New Construction: Yes ❑ No (R FHA/VA: Yes ❑ No El <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_-.,./__.a...........Materia�_____ _.....................-- <br /> ,No, of compartments------------7— Size----- ir_, __ _�_`Liquid depth_......... _ ____Capacitya_. <br /> Disposal Field: Distance from nearest well-.z/.a_o---Distance from foundation_.-.z ......Distance to nearest lot line.....!. .v <br /> ® Number of lines........____�_� 7 _Length of each line��. ---------Width of trench______--_-_ _r............._� E <br /> Type of filter material..._.—:__Depth of filter material---_Z.._r_____Total length-------- __--- <br /> Seepage 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--------------------- -=--.I--------Depth------------------------ ----------------------Liquid Capacity............................ f <br /> Priv Distance from nearest well____._ - +_ ___._Distance from nearest building <br /> ❑ Distance to nearest lot line----------------__" } t <br /> Remodeling and/or repairng (describe):_' _-_-- -_- _.__ _____ _U, - ���_- ------F .. <br /> ------------/I--•----------- z-- -- -------- ------- <br /> •----•- ------------ k <br /> - '--------- -.. -- ......--- --------J'---------------------------------------- ------------------ ------------------------------------------------ <br /> I hereby certify that I have prepared this application and that the work will I be done in accordance with San Joaquin County { <br /> ordinances, State laws, and rules and reg ations of-+he;San,Joaquin Local Health'District. <br /> l Y <br /> (Signed)._­.. ------------------------------------(Owner and/or Contractor} <br /> SY ' --------•------------------------------------------ --------------------------------------------------------------------------(Title)-------••--------•-------------.-------.---- -- ....--...--.-- -- <br /> (Plot plan,showing size of lot, location of system in relation to wells, buildings, etc., can b6. Ia'ced on reverse side). <br /> _ <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------- - ---- ----------------------------------------- DATE'--------} _— - ---------- <br /> REVIEWEDBY------------------------------------- -- ------------------- ---------------------------•----•------------- DATE!--------------------------------------------------------- f <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------- --• ------------- DATE------------------------------------------------------------- <br /> Altera ions apd/or recommend•ations:---------- ------------------------------------------------------------------- -------------- ---------------------&------- --- <br /> - ----- - `� -� ------- ----------- -•---- '- ..--•� �=--�- i <br /> _-. -----•------- . 4 •- <br /> -v--. 0`-- ---------------------------------­----._.... <br /> --------------------------------------------------•------•--------------------------------------------------------------------- ------------------------------------------------------------------------------------------- <br /> -------------------------------- -- ------------- ---- - -------------------------------------------------------------------------------------------------------------------------------------------------- <br /> FINAL INSPECTION BY:---/- ------"?--------------------------------- Date---------------- <br /> Z� _. --�t<-_3---------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 114 Sycamore Street 205 West 91h Street <br /> Stockton,California Lod],California . Manteca,California Tracy,California a <br /> ES 9 REVISED B-59 2M 5-62 ATLAS <br />