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FOR OFFICE USE: -� <br /> --------------------------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. . .. __. <br /> --------------------------------------------------------- (Complete in Duplicate) <br /> --------------------- <br /> This Permit Expires 1 Year From.Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local i-ealfh rJistrict for a,permit to construdnstall the work herein described. <br /> This application is made.in.,compliance.with County-Ordrfiaiice'No.549. <br /> . ..JDE AN� LCATION ----- -�g <br /> n <br /> . _ -- - ._... <br /> Owner's NamePhone..................................... <br /> c <br /> --------------------- - ------------- Phone----•--•...-------------•---------- <br /> Contractors Name------•---• ------------------ ------•- •------•-`-"-'-------7'•--------------- ---•---------------._ .. <br /> Installation will serve: Residence Apartment House Commercial ❑ -i <br /> p ❑ ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: --- Number of bedrooms . Numbe <br /> rbaths ---- _ . <br /> Lot size ' ___________________ <br /> Water Supply: Publics stem ❑ Community system ❑ Prive To Waiter <br /> f 4 <br /> Table -------- it. <br /> Character of soil to a depth of 3 feet: ANT❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe❑ Hardpan <br /> Previous Application Made: (If yes, ate--------------------) . No ❑ New Construction: Yes E]4,1\10": ❑ ' FHA/VA: Yes ❑ No ❑ <br /> TYPE,OF INSTALLATION AND SPECIFICATIONS: I i <br /> (No septic tank or cesspool permitted if public sewer is available within 200 fee -.) <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------Material___.-.________.____._-_______........._____-__... <br /> ❑ No. of compartments-------- ------Size-------------- ----------------Liquid depth_. ; Capacity <br /> Dispos Field: Distance from nearest well------ -_-._Distance from foundation-___'ZA:.......Distance to nearest lot line-.S.__...... <br /> Pe <br /> ; Number of lines------• _ _-__-__ Length of each line------- th 'of trench.----..�--'- <br /> ---------• ----- <br /> Type <br /> of filter material.-.,� ......Depth of filter material----__-/.Z-_._____Total length........3-0-_.°------------------- <br /> foundationf ! <br /> Distance to nearest well____�_t<'_U_--.____Drstance from ___-._j._G2____....Distance #o nearest lot I�e._�S .__.__i-'� <br /> ❑ Z44,ljN i Lining material--,4.4V k----.Size: Diameter-Z- A•--- Depth -�' •-•-•---••-----.. <br /> Cesspool: / Distance from nearest well-----------------Distance from foundation---------------.-_..Lining material-.--.._____:___�_._.__:` <br /> ❑ Size: Diameter.---------- ----._Depth-------------------------------------- -------------Liquid Capacity----------------------------94 <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.___-_--__._._---__---_--_-_--__ <br /> ❑ Distance to nearest lot line ------------ ­ <br /> ----------- --------------------••------------ ---------------•--------------- <br /> i <br /> orrepairing .(descnbe):--------- ----•-------------------------------••--•--•------------•---•------------•--•---------•----•-----------.._...------•-•----•--...---------- <br /> -------------------------------•---------------------------•••----------------------------------------------------•--------------------------------------•---------•--------------------------------------•-•-•-------- �l <br /> ------------ -------•---• -------- •--•-••---------------------------------•--- <br /> ------------------------------------------------------.-----------I---------------------------------------------------------------------- .---------------------------------------------------------------------- - <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, an. rules and regulations of the San Joaquin Local Health District. i <br /> (Signed)--••-•------------ -- - --•----- -- ---- --------- --- - -------------------------•------------------------------- --•---.--- (Owner and/or Contractor) <br /> gY= -- -- ------— ------ - -- - ---- (Title)------------------------------- - - <br /> (Flof plan, showing size of lot, location of syste in relation to s, u gs, raft., can be placed on reverse side). <br /> I <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_. ----- - --- --------- ----------- DATE_..1�_/3- 6 <br /> ---------------------- r <br /> REVIEWEDBY----------------------------------------------------------------------------------------------------------------....---------- DATE--------- <br /> BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------ <br /> Alterations and/or recommendations. <br /> ---------•-••-•--------------------•-•---------•--- -----------•-----------•------------- ---------------------------••--•---------------------------------------------------------------------------------------------------- <br /> ------------------------ --------------------------------------------------------------------------------------------- <br /> ------------------------------------------------- <br /> ---•-------------- ------------------•----- • ----------•-------------- ------------------------------------------------------------- <br /> FINAL INSPECTION BY --_� r- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT I <br /> 130 South American Street 300 West Oak Street 134 Sycamore Street 205 West 9Th Street j <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES,9 REVISED 0-59 21A 5.62 ATLAS <br />