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............ . . ............. APPLICATION FOR SANITATION PERMIT Permit No. Jl� <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 Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with CC unty Ordinance No. 549. <br /> JOB ADDRESS AND LOC TI - f� AIaO�S / <br /> Owner's Name..- ---- -- -- .......... .._........--. ----- ---- Phone..................... --------- <br /> Address.. ..a........KJ_. ­,?C-....... 7,377,,h� ........ ..................................................... <br /> Contractor's Name-------- . ... . .... ..... ......... ... r -- -------------------------------------------------- Phone <br /> Installation will serve: ResidenceX Apartment House E] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __Z. Number of bedrooms ,?.. Number of baths .-1- Lot size .. 7•�.�—�._��Ol............... <br /> Water Supply: Public system ❑ Community system ❑ Private Qr Depth To Water Table ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe(1 Hardpan ❑ <br /> Previous Application Made: (If yes,date.. . .... .. ..) No,k New Construction: Yes or No ❑ FHA/VA: Yes ❑ No Nr <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well.--Q../.Distance from foundation.. ......... Motanel..... ........ ............. ............. <br /> No. of compartments..... _.-.Size_.W1iY40*--. ---Liquid depth.___er. ............Capacity,Ai70Q&-je4 L <br /> Disposal Field: Distance from nearest well___.'_ Distance from foundation-../ Distance to nearest lot line.._s ..�... <br /> ..........._ Length of each linc._._4Z�A__ �....._.Width of trench......Z-S/. ................ � <br /> Number of lines___._._. ._.. � ,fir g '°� <br /> Type os filter material__ —.610r_.---.Depth of filter material../9-1.... Total length____,ls . _.._................... cx.� <br /> Seepa a Pit: Distance to nearest well -��_ ... ..___Distance Bjorn f undation._Z-Q_...._...Distance to nearest lot line-.�---..-.-- <br /> Number of pits.....------------Lining meal riel. __ Size: Diameter._,70...... Depth_ ol. ................. <br /> Y. <br /> Cesspool: Distance from nearest well.................Distance from foundat'on--------------------Lining material..................................... <br /> ❑ y Size: Diameter. ...........................Depth..... ........--------------------------------------Liquid Capacity............................gals. <br /> Privy: Distance from nearest well ....................., ....... . . . .....Distance from nearest building......................................... <br /> ❑ [istance to nearest lot line....... •-------------------------- <br /> Remodeling and/or r pairing escribe):--_h ;hGLr+� f ----------,!+:�--_-._�Q .__..- .......... <br /> �.............. <br /> ' `" <br /> ----------------•----•-- ..._.............. .:........ .... --._..----------.-..--------.-..-------------------.-------_------------ <br /> -� ,. ,;..----.•-----..--•.................................................... <br /> ------------------------- ------- - -------------- ...................---- ---------------------------- --...----•-------••--------•------•-----f.---•--... ------•--.......-----------.....----.----------.........------ <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, and rules and regulations of the San Joaquin Local Health District. <br /> a <br /> (Signed) )- ..... .. . _.. ......--(Owner end/or Contractor) <br /> By -----Zio- - ----- .---- ...4 (rtle)------. -...��t _.... <br /> (Plot plan, showing size oton of system in elation to we uildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY 1 ------ D;$Tfr.. �"�V <br /> ........................................ <br /> REVIEWEDBY ...........................................................................••- DATE......................... •-------------------------------- <br /> BUILDINGPERMIT ISSUED.................................. ..........................._.................... ................. DATE-----------------.._.--...................................... <br /> Alterations and/or recommendations;................. .......................... -- •--- ---- ---•-•----....._......_..._..............._.................................. .........--..... <br /> .................................... I..............................................................................•---------.. .....................................................---••----------------•......-•-•--...... <br /> ........ ....... ..................................................... .. ...... ............................I................... ..................................................................................... <br /> ............................ ............................................ ........... ... . .. ...................._..._............ ........... . ......J ................... ..... ........................... <br /> ............ .......................................__._ .............. ... . ... .. ............................... ... ...... ................ <br /> "� 1 <br /> / r Date 3l / ................ <br /> FINAL INSPECTION BY:....... �_. !�, .. ....................... <br /> r ' <br /> SAN JOAQUIN°LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Nest Oak Street 4lA24 Sycamore Strout 205 West 9th Street <br /> Stockton,California Lodi,California MontA,California Tracy,California <br /> ES 9 REVISED B-59 2M 5.6Z ATLAS <br />