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rUK Urrik-t uat: <br /> --------------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. .. __ d <br /> ---------------------•----------------------------------- (Complete in Duplicate) Date Issued ..--3/ <br /> --------------------------------------------------------- This Permit Expires 1 Year From Date Issued <br /> ..._/..2.�_ <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with CounOrdinance No. 49. <br /> OL— <br /> JOBADDRESS AN LOCATION--- -- ----- ------ ,--•• j6;� -----------------------------------------•-------------------------------------- <br /> Owner's Name----- - -- ----- --- -------------------------------------•----- Phone.................__. <br /> Address. <br /> ------------------------------------------------------------.............................................. <br /> Contract'or's Name C - ` !'� --------------------- - ......__... <br /> • ......................••----...._._..----...... Phone.--•-----....---•-••---• <br /> Installation will serve: Residence 2-'-Apartment House ❑ Commercial ❑ Trailer Court ❑` 'Motel ❑ Other ❑ <br /> Number of living units: --f--- Number of bedrooms .�. Number of baths _�._. Lot size ....1: .ffXrR%a._F--------------------- <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table "y�ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe�ardpan ❑ <br /> Previous Application Made: llf yes,date----- No �New Construction: Yes ❑ No ❑ 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 /> ti Tank^ Distance from nearest well_________________Distance from foundation--------------------Material............................................ <br /> .___. <br /> No. of compartments--------------------------Size--------------------------------Liquid depth_-...._.-----------------Capacity_____.._______._....... <br /> Disi d: Distance from nearest well_�.?EP Distance from foundation---/Q__.._.....Distance to nearest lot line.._5.../.... <br /> posaPe Number of lines----------- ___._ _ ____ _Length of each line-----------&,O-Z-__..Width of trench_________.. '0 <br /> Type of filter material.-s�L______�__ _..Depth of filter material___.__-/_S_`0----Total length..... ................. ____ <br /> Seepage Pit: Distance to nearest well_ ___.Distanm fundation...f.D......._...Distanf� to nearest lot iine�_ ---------- \ <br /> Number of pits------- -------------Lining material..._ &CA.___.Size: Diameter---3-13------.___,Depth____ . .- �} <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-------------------_Lining material------------------------------------- <br /> El 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 /> r <br /> -----------------------------------------------------------------------------•--------------------....--••---.....---------------------------------------•--------------------------..._...-.------------------------------- <br /> ---------------------------•-----•------------- -----------------....--•----------•-------------------------------•------------------------------•............--------•--------•--------------••-------------------------- <br /> I herebyY C"fhat' repared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, 5tand regulat' ns of the San Joaquin Lacal Heel+h District. <br /> (Signed)_______ ____ ------ ------- -_----- ner and/or Contractor} <br /> t ' <br /> By----------------------------------- (Title}------......._Qie- ---- ............... <br /> (Plot plan, showing size of to+, location of system in relay to wells, buildings, etc., can be placed'on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED �BY_--- - ----------- DATE...._. ---'"-•--�--�•--�---�--�-------- <br /> 4 ------ ----------------- <br /> REVIEWEDBY........................................... --------------------------------------------------•------ ------------------- DATE---------------; <br /> BUILDING PERMIT ISSUED-----------------------------------------------------------------....-------•----------------------- DATE------------------------------------------------------------- <br /> Alterations ............. <br /> ­----------------------------- ---KA- <br /> --------- - <br /> -------------------------------- <br /> fF <br /> ____________________________________________________________ <br /> II <br /> FINAL INSPECTION BY:..-j........ ------- ----------------------------- Date_. t---- 63.._---------------------•------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wort Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> E8 9 REVISED 8.99 2M 5-61 ATLAS <br />