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FOR OFFICE USE: <br /> ------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. _--•---/-----...--... <br />-------------- - ---------------------------------------- (Complete in Duplicate) <br /> w _ - Date Issued .... <br />-----------------------".___..___----------.--------- This Permit Expires 1 Year From 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 /> �T;,hiis.�a.P lication is. made in compliance with County Ordinance No. 549. <br /> JOB,ADDRLS AND LOCATI N " 0� <br /> y - -- -- <br /> - --•--- Phone..................-------------•--_ <br /> Owner's Name------------ - 9.�t.rG "•----------------------- <br /> : .... - ' <br /> ll <br /> Address - - <br /> Contractor's Name.-- - - - ----•-------•-•-•-•--•--------------------------------------------------------------------------.--------------- Phone................................... <br /> Installation.will serve: Residence T_ Apartment House ❑ Commercial E] Trailer Court [3 Motel ❑ Other <br /> Number of living units: ._----- Number of bedrooms _ __ Number of baths 7i__ Lot size _. __ _ __ <br /> ------------------------------------- <br /> XS <br /> Water Supply: Public system .❑ Community system ❑ Private 0 Depth to Water Table __ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam K Clay Loam ❑ Clay ElAdobe❑ Hardpan Cl <br /> Previous Application Made: (If yes,date___________________") No ® New Construction: Yes 0 No ❑ •FHA/VA: Yes-E No-O-`-, <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__-47:0____-Distance from foundation---l a...____...Material___ .................... <br /> No. of compartments------1-----------------SizeAf. -----------...Liquid depth------4------ .________Capauty..- � -•- p'V <br /> Disposal Field: Distance from near t welL_��_.-.-.-Distance from foundation__..C.:O----------Distance to nearest lot line.___�F. <br /> Number of lines_-_.: .. "_"_ _.e___:;.___-.L'ength of each line_____10------------------Width of french...... �'____--. -_._______ <br /> T e of filter materia _ _� <br /> Depth of filter materlal.._ 8-------....-Total length__._ "5 -d•"-..---_ <br /> yp '[ <br /> Seepage Pit: Distance to nearest well---_.--_ �.____--Distance from foundation....................Distance to nearest lot line____.__......_... <br /> El Number of pits----------------------Lining material-- -"""""""-Size: Diameter"_--•.----------------..Depth.--.---•-------•_-••--------__---� <br /> Cesspool: Distance from nearest well____-t.........Distance from foundation-------------_----Lining <br /> ❑ �!t .,a..De pthmaterial___.______. __.______--.---..- <br /> -_-_ <br /> -------------------------- ----------------Li Liquid Capacity -------_--_gals.Size: Diameter---- ---* <br /> Privy Distance from <br /> nearest well-'--- ,.------------ ---------- <br /> ---------- """--Distance from nearest building---------------------------------.-•------ <br /> ❑ Distance to nearest.,_ st lot line------ ------------------------ <br /> Remodelingand/or repairingl(describe)---------- ----------------------- ---_-----•-----------------------....----•-•--•--•---------•---------------- --------------------------------­. <br /> -------------•-----•------------------------------------------------------------------------. ---------------------------------•-.._...-------------•--------•----------------•-------------•----•------------ <br /> I hereby certify thaf 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 of the San Joaquin Local Health District. <br /> [Signed} � ... _ - _ _ (Owner�ertd/or:Contr for}_�: <br /> . - - - s: - . = --- <br /> x - --- Y--------------------------•--------- --------- <br /> ..------- <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-- ------------ --------------------------------------- ----------------- DATE------ ---------------------------- <br /> REVIEWEDBY------------ ----------------- f ------- -•---- DATE-------•---•---------------- <br /> IBUILDING'PERMIT ISSUED------------------------------------------------------------------------------__------------------- DATE-----_---------------------- -----------------------------•- <br /> jAlterations and/or recommendations:--------------- ------------------- ------------ -----------------------------------------------------------------------_.----•----.-.---•--"---•"-•-"-------- <br /># .................•---------"---------•-•-----•-- ------------------------------------------------------- <br /> t <br /> --•--•----`----- --------------------------------------_:---_...---------------------------------------------- <br /> ------------------------------- --------------------------------------------------- <br /> --•-----•--------------•--•---------- ----- ----------------- <br /> FINAL INSPECTION BY- Y <br /> Fys" 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,Callfornia <br /> ES 9 REVISED 6.59 2M 5-61 ATLAS ._ - <br />