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FOR OFFICE USE: <br /> ------------------ <br />-------------------------"_____----------_--------------- APPLICATION FOR SANITATION PERMIT Permit No. AY <br /> 3._-__. <br /> _ (Complete in Duplicate) <br /> ------------------- This Permit Expires f Year From Date Issued Date Issued ...................... <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct tinstall the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> / E <br /> JOB ADDRESS AND OCATION ,G> ----•,-- _ --. ,���► <br /> ........_.. !'w fi'''r viz_ <br /> / "'�C <br /> Owner's Name.. - <br /> Aj <br /> ------- -•----------- 4 <br /> hone <br /> 4A <br /> Address € <br /> - ------------ <br /> ----- ....--- -•-------------.....---•------------------•-- <br /> Contractor's Name..' ' I --1-3........... .r..: Phona. <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units:._ ---• Number of bedrooms ----3. Number of baths _2n. Lot size .._�C� .................................. <br /> WaterSupply: Public system'.[] Community,system ❑ Private Od Depth to Water Table ft. <br /> Character of soil to a depth of 3 feet: Sand ❑' Gravel ❑ Sandy Loam W Clay Loam ❑ Clay ❑ 'Adobe❑ HarC]+�dpan <br /> Previous Application Made:,(If yes,date--------------- No JV New Construction: Yes 4 No E] FHA/VA: Yes El 'No <br /> TYPE OF INSTALLATIONaAND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer isavailablewithin 200 feet.) _ <br /> i XT <br /> Septic Tank: Distance from nearest well._S'D-------DistanW from <br /> ; -- foundation--- b..........Ma <br /> erial_._ <br /> artmentsNo. of comp ---�� ---------------Sie -. ----, _--Liquid depth---- / ----------f-�---F-Y-CIIa�p[Ia,cL�ift�yS.r.!f!......_................ <br /> Y ft . <br /> " <br /> \Disposal Field: Distance from nearest wellZ_0--------Distance from foundation.../.A----------Distance to nearest lot ine____rl...__.... <br /> I Number of lines.._.{_. � _'_____________ "-L'erlgth`of each line-----R�-----------------Width of trench_-____r3 _______._._______ <br /> Type of filter material :_" K _,Depth of filter material____/_`-g_-___---_-_.Total lengtht-.1.4P__-�...................... <br /> t = <br /> Seepage Pit:. Distance to nearest wel __________•-________--Distance from foundation--------------------Distance to nearest lot line................. <br /> ❑ Number of pits--_-----------------Lining m te'rial------------------------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 -_-__.-"_-_______________----------------------Distance from nearest building--_._._._______________--.----_--___-_-__. <br /> ❑ Distance to nearest lot line------------------------------------------- ------------------------•-•-•---------- <br /> Remodelingand/or repairing (describe(= ----------------------------------------------------------------------•----------------•-----•------...-------------------------------- <br /> ---------------------------------------------------------•--------•---------------------------------............------------------------------------------------------------------------------------------- <br /> . <br /> --------------------------------•------------------•-----•--••----•--------- ­--------------------­- ---•--------------------------------- •--••------ •---------------------...-----------------... ---- <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, d ules and regula+ions of the San Joaquin Local Health District. I <br /> -'----- ` --------•-----------------------------------------------•-------•- --------• •----------------------(Owner and/or Contractor] <br /> {5igned]_.. I i <br /> By:------•..........................•-----....------------------------------------------------------------_----------..._..--------_(Title)-----------------------•------------ ----- -------------- <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 /> lie- <br /> APPLICATION ACCEPTED BY__" DATE____-/cR_6_�'✓'___________________ <br /> REVIEWEDBY----------------------------------------------------------------------------------------------=------------.................... DATE--------------- .... <br /> BUILDINGPERMIT ISSUED-------------- ----------------------------------.....----------------------------- DATE-------------------•------------------------ --------- <br /> Alterations and/or recommendations. -----------------------------------`----------------------------------------•.........-----------------------------------------.._..------- <br /> -------------------------------------------------------------- ----------------------------------------------------•------- .............-------------------------------------------------------------------------- ' <br /> r <br /> --.------•-------- ----------------------------------------------------------------------------- <br /> ...................•---------------- --- . ................................... -----------------•-------------------------------------------- ---------------------------------------- ---•---•---------------------------- <br /> F1NAL fNSPECTIONBY���. . --------------------------• <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 1 <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> CS 9 REVISED a-59 2M 0-151 ATLAS <br />