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................................ A--CATION FOR SANITATION PERF Permit No. ..... ._ _ -... <br /> -....................................---- ....... (Complete in Duplicate) %MOP ,L -9j <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 a permit to construct and install th:2Z crbed. <br /> � This application is made in compliance ith County Ordinance No. 549. <br /> 6e4_ 4 <br /> JOB ADDRESS ,yyD�'L'OCATION .: ..... .. .. ....- - 17... ..-...................... � a...... <br /> L Owner's N�ami�,�e. .- - _............................... Phone..._......._....../........._... <br /> Address.-:,2 -.%I....._ � � -� ......... <br /> Contractor's Name-an - - <br /> - ---------- -�lIL2[yj�.-- ---- -... - <br /> . .............- ............ Phone..............................._. <br /> Installation will serve: Residence [!Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel s❑' ,other ❑ <br /> Number of living units: .._ Number of bedrooms _v2-. Number of baths ...1.. Lot size ._-90-Lam -­- <br /> bw <br /> ---- <br /> Water Supply: Public system ❑ Community system ❑ Privatex Depth To Water Table-Ad.- ft. <br /> Character of Will to a depth of 3 feet: Sand( Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan <br /> Previous Application Made: (If yes,date:...................I No ❑ New Construction: Yes ❑ NoX FHA/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 is Tart,: Distance from nearest well..............-Distance from foundation....................Material............___.............................. <br /> No. of compartments_..-.....................Size-----------__................Liquid depth..........................Capacity_-.................... <br /> Distance from nearest wellr5�40.._....Distance from founds ion.,/6. ......Distance to nearest lot I fe_._�....... <br /> [� Number of lines........�¢..�._. .. ./Q} Length of each Iine.41bar�....Width of trench..07,l/...... ...... ..... <br /> / Type of filter materia1M4'_AKL�....Dopth of filter ......Total .length....._.___.....-Z--�------__-- <br /> Seepage Pit: Distance to nearest well......................Distance from foundation...................Distance to nearest lot line................. <br /> ❑ Number of pits......................Lining material....................---Size: Diameter............. Depth................................. <br /> Cesspool: Distance from nearest well.................Distance from foundation....................Lining material............................. <br /> ...._� <br /> ❑ Size: Diameter................ ----.._.._-Depth....._-------........................•----.....Liquid Capacity.......................--..gals. <br /> _ Privy: Distance from nearest well................................................Distance from nearest building................_._.................. <br /> ❑ Distance to nearest lot line.........................................--•-------•-----...._......................_........................._.............--_...... <br /> Remodeling and/or repairing (describe):--------................--------.......... ....................................... .......----•--......------...........--..... <br /> ` <br /> ........--............................. •--•------•...............................•----........................•--.I.....--.........-----............................... ..............------------- <br /> .................................................-.................................................................................._....._...••••••••----..................--................-------......_...... . <br /> ----- --........__. ....... ..............................-...............---.................................................................................................................................. <br /> I hereb certify at I have prepare t is application and th t the work will be done in accordance with San Joaquin County <br /> ordinances, s, end rel end re u tions of the San Jouin Loral Health District. <br /> (Signed)----- .. .. ... .............................., D ......... ..... - - ...._.... rand/or Contractor) <br /> By:---- --------- ...... V43^"`�"... . ------ -----..._........._(Title) .._ ._..... ......_ <br /> (Plot plan, showing size of lot, location of system in relation +o well uildings, etc., can be pissed on reverse side). <br /> _ F R DEPARTM T USE ONLY / <br /> APPLICATION ACCEPTED BY........... E. r............................-..-----... DATE.-------- -• ....-f ' G ........... <br /> REVIEWEDBY---...................-----......... .................._.._..._...........---------......----......--.--------... DATE........ .... ......................... ------------- <br /> BUILDING PERMIT ISSUED......................................................._......_...................................... DATE. ------------------_----------------- <br /> Aberafions and/or recommendations:.................. ..........._....... ---............. ----...----....._. .....••........----..................---------.............--... <br /> ....................................................•-----......._.•--•---------•----....._-.._....-----...------...................------.......-------. ... ...._........._............----- <br /> .................................................. • ........................_................................................ -•-----------------------•--•------- <br /> .........._.................................................... .............. .... ........_......._.._......... - - ................................................... <br /> .------------------------ <br /> . ....--... <br /> ............. ........ <br /> ........ <br /> FINAL INSPECTION BY...., _-........................ ................ Date....---....�..-... ............................. <br /> .....----.. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 Soath Amorhan Shoat 300 West Oak Sr rot 124 Symmoro Shoot 205 Wosl 9th Sbol <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED a-59 2M 5-62 ATLAS <br />