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FOR OFFICE USE: <br /> ------------------------------------------ ------ _ <br /> _.._.___.___.-----_-___---__________________ APPLICATION FOR SANITATION PERMIT Permit No. <br /> .... <br /> --------------------------------------------------------- (Complete in Duplicate) 7/7 �,/ y <br /> ----- ------ -------------------------------------------- This Permit Expires 1 Year From Date Issued <br /> Date Issued ...-------- <br /> .:...... <br /> Application is hereby made to the San Joaquin Local Health District for permit to construct and install the work herein described. <br /> This application is_made in compliance with County Ordinance No. 549. 3 <br /> JOS A DRE55 AND t CATION..---------- - --�L� �� ....... <br /> .:__ <br /> Owner's Name_----------- _ ------------------------ -t-•-- ----------------•-----------------..__ Phone.................................... <br /> -• --------•-------- <br /> Address--•--•-•••---------- C22.. :.. � <br /> Contractor's Name.---- P f _ .Phone....._}... <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court [Mootel.❑ Other ❑ <br /> Number of living units: _/___ Number of bedrooms _c),_- Number of the ._Z_ Lot size -------Z_______ <br /> Water Supply: Public system E] Community system ElPrivate Depth to Water.'Table g�e. ft. Fes. <br /> Character of soil to a depth of 3 feet: Send ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑, AdobeHardpan F] <br /> Previous Application Made: (If yes,date-----------_--------) No ❑ New Construction: Yes Erl o ❑ FHA/VA: Yes ❑. No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: R <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) s <br /> S tit Ta k: Distance from nearest well�� ' Distance from foundation_. �' <br /> P� ------- ------.Me Material <br /> No. of com artments__----cam--- Size_ __` _+6 Li uid de th------- ____ _.__Ca aci 767CP' <br /> Disposal F' ld: Distance from nearest well_,�_d___.___._Distance from foundation_3-.e_______.Distance.'to nearest lot line-----35�_..... <br /> [ ----Number of lines..... <br /> _ <br /> ----- /1_Length of each line----- --1___f�_...Width of trench----. .� ........._�_......_ <br /> Type of filter material., t_. ___Depth of filter material_._... __.-_Total length___________________�4__--.-__...i <br /> Seepage Distance to nearest well/Q0._ .___.-. <br /> _ Distanct-f m fdundation___9Q.194-.1"_ <br /> Distance to nearest lot line_....`---------------- <br /> .. <br /> Number of pits-----/------------Lining material.. _ - .,---Size: Diameter----- ----..._.Depth------! ---------7____.--5 - <br /> CesspooL• Distance from nearest well_________________Distance from foundation-.-----------------.Lining material-------------------------............I <br /> 11y <br /> - Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacit ---•-----------------------gals, <br /> Privy:- Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------------------- <br /> ❑ Distance to nearest lot line______________'_____-__" --- <br /> f = <br /> Remodeling and/or repairing (describe):-------'41. , ''? -------- ---------------•-------------------­----. <br /> 4 <br /> ..............•------------------------------------------------------------------------------------------•----.........._..-------•------------------------------------------------------..................................... <br /> ----------------------------------------••----------------------------------------------------------------------------------------------------------------•----•--------•-------••------------- --------------------------- <br /> I hereby certify the I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Stat nd rules and regulations of the San Joaquin Local Health District. <br /> (Signed) = -- �- �(Owniir and/or Contractor) <br /> By:----------------_-----........------------••----•-•-------------- (r,+le}- / -------. --_--- ----------- ' <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildi S, etc., can be placed on reverse side). <br /> .FOR DEPARTMENT US ONLY <br /> APPLICATION ACCEPTED BY--- ------•--------- ---------------------------------------- DATE...•-P6`-3---G---- -------------- <br /> REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE------------------_-------- <br /> BUILDING PERMIT ISSUED--.--.,........--------------------------------------------------------------------------------_.. DATE------------------------------------------------------------- <br /> Alterationsand/or recommendations:---- ------------ ----------------------------------------...-------------------------------------------•---•--•--------•-----••-•---•------------------------ <br /> --------•--••----------------------•--•-------------•------•-----•-•------•--------------------------------------------------------------------------•---•---•----------------•-•-----------------•---••---------•---------- <br /> .._-_----------------------•---•-------------------........._...---•------------------------•---•-------.---._--.-------------•-----_--._•-_------•---•-------------------------------.....--•------------------------•-•----- <br /> --•--------------------------------- --'-'- -------------------------:..... ------------------------------------------------------------------------------ ------ ------••---•------•----------------•---------------- <br /> FINAL INSPECTION BY% Date------�- _-?�".�_.r�• �------------ <br /> �,�------------- <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 /> rD 9 REVISED 9-B9 ZM 3-61 ATLAS <br />