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FOR OFFICE SE:-�' <br /> z... 10,` S U�'f 6� t� <br />-------------------------- ----- ----------------------- APPLICATION FOR SANITATION PERMIT Permit No. ....................... <br />-------------------- ----------------------------- (Complete in Duplicate) / )--",�,f, ( <br /> This_Permit Expires 1 Year From Date Issued <br /> 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 Ordinance o 549. <br /> JOB ADDRESS AN CATION. l Q---•----- J - --------- ------.... 1 <br /> Owner's Name------ -------/ Phone <br /> r ___ -- -----; <br /> e <br /> Address---- .... =•--------------•---•----_------_---- <br /> ---- --- ----------•----•------------ --- - - - - <br /> ...----•.._ .. <br /> Contractor's Name- --------------------- ------ Phone.................t <br /> 1, - -- <br /> Installation will serve: Residence �partment House ❑ Commercial ❑ Trailer'Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __. Number of bedroom's __ _ Number of baths _ '.. Lot size <br /> Water Supply:-Public system �ommuriity system ❑ Private ❑ Depth to Water TableL�_ 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 �FtiA/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 /> S t'c nk:- Distance from nearest well_________________Distance from foundation-__-- :.___.___.Material____._________________........................... <br /> <r <br /> Disos No. of compartments___•-__....-_--:.:.:;`::Size-"==-•----------------:__:Liquid-depth: .---•-•---.•:_- Capacity_`.................... <br /> p al F"field:. Distance from nearest wel _ -��__Distance from foundation....,l0....~ Distance to nearest lot line._•...,..-.-.. <br /> >. f d r �r <br /> ( <br /> Number of lines-------1___: _____ _ Length of each line.... 70... of trench______�V... _____`_..___ <br /> Type of filter material._ �_ —1__12 Depth of filter material.._./.g--______._Total length______________________ t _______.-__ Q <br /> Seepage Pit: Distance.to nearest well----------------------Distance from foundation__..................Distance to nearest lot line,................ <br /> ❑ Number of fits----------------------Lining material----•__-__.------------Size: Diameter-------------------f-.:Depth__.........._......______._..._ <br /> Cesspool: Distance from nearest well.................Distance from foundation___._._______.-___.Lining material•-__________•_______----------_---_-- <br /> i Size: Diameter------------------------- ------------De th----------..---.----- ---- Li uid_Capacitygals. <br /> Privy: Distance from nearest well----------------------------------------------- from'nearest building____________________._._.___________--__-- <br /> ❑ Distancejo Aearest lot line-------------------------------------------------------------------------------- - ------------------------------------ <br /> Remodeling and/or repairing (dE scribe): ............... f�........................ <br /> ----------------------------------•------•------••---•-----------------------------------• ----•----••-------------------------------------------=--••---------------•-•-.-- <br /> ----.------••-•---------•- •-••----•-••------------------------------------------------------------------------------------------------------------�......---------------•--••------- <br /> f <br /> ----------------------------- -------------------•-•---.......-----•-•-•---- •---------•-•--. -----------.......I-------------------------------------•---•--------•---------- •....-•-•---------------------------- <br /> I herebyy ce that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, 5t la s, and rt es and regulat1 of the San Joaquin Local Health District. i <br /> nor and/or Contractor <br /> (Signed)------------ -a----•�------------------ ----------- -------- - - - ---------------------------------------- ---( / ) <br /> --- ----------_------ Title ---------�............... ---------- ----------------.-------- -------•- -- (Title) -..-----'...------ <br /> (Plot plan, showing size of lot,location of system in relation to IIs, buildings; etc.;can­be placed on reverse side). I <br /> l % FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY- - `---_,_--__- _ <br /> G<+�-----�=�--�----------------------- DATE...---y�1----2--- ------ --------- <br /> REVIEWED BY-------- <br /> -------------------- ------------------- DATE------------------------------------------------------------ <br /> BUILDING PERMIT ISSUED------ <br /> --------------- ----------•-----....-..----------- ---------••-------------------- DATE---------------------•-----------------•- <br /> Alterations and/or recommeniations:---------------------------------------------------------------------------------------- •---•••-•............................................................. <br /> 1 t <br /> -----•--------------------------------- ------------------------------- <br /> 1 ` <br /> ` <br /> 11 s! <br /> 1 F J <br /> I <br /> FINAL'"1NSPECTION` Y::"�' 4 Date: = � <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REWSED 5-59 YM 8.61 ATLAS <br />