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FOR OFFIC SE- N <br /> q <br /> _____________ ----------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .. <br /> -- ------------------------------------------------------ (Complete in Duplicate) <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 County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION._.-���`�--- _L- ____ r <br /> Owners Name_..--� -----��y__-�_�'_._�_-_�-••-•--•-•-••---...-•- ------------------- ----•--•-----••------•----------..-- Phone---A_s.F-AIW47�........ <br /> Address----------------------------- ------------------------------------------------------------------------------------...------------------------------•------------..-..-------- <br /> Contractor's Name --------- ��•-----------•----•. --------------- Phone................................... <br /> Installation will serve: Residence 2-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I <br /> Number of living units: ----- -- Number of bedrooms - _- NumbeZpth <br /> ths ----/-- Lot size _ U? .. %3 .............................. <br /> Water Supply: Public system ❑ Community system ❑ vate PriTo Water Table -35—ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Er--Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No [>r--�New Construction: Yes E3---No ❑ FHA/VA. Yes ❑ No �J <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septi TAY, Distance from nearest well-----------------Distance from foundation--------------------Material-------------................. ..-.-----_-----. <br /> No. of compartments-------------- ------.....Size-------•------••------------•---Liquid depth---------------- ---------Capacity...........------...... <br /> —�t � <br /> Dispo � Distance from nearest well--fo-._-_-_-Distance from foundation...M--------.--.Distance to nearest lot line.!�$............ <br /> ❑ ti� Number of lines-----------/---------------------Length of each line-----------------------------.Width of trench.------r !'_=_....--... <br /> Type of filter material..-lxt-----------Depth of filter material--1.,K."-----.----Total length_---•_•-- 7-cy_.------------------- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation-----..............Distance to nearest lot line__._---.--_----._ <br /> p Number of pits----------------------Lining material-----------------------Size: Diameter--.-.------------------Depth--------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-----.-------_-.--.Lining material------------------------------ <br /> ❑ 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 /> --------------•--...----------------------•--------••------•--•-----------------------------•------------•---•---•---•--------•---------------------------•----------------------•----------••-•------......I------------ <br /> --------------- <br /> -------•--••----•--•-- ------------•----------------------------------------------•------------------------------------•----------........................--------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------•-------------------------------------------------------------------....-------------------------------------------------------- <br /> 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 the an Joaquin Local Health District. <br /> (Signed)----------------------------------------------•- -------•-----------------------•------------------------------(Owner and/or Contractorl <br /> By:------------- ----------------------------•---------- /------------------------------------------(Title)------------------------------- - - `y <br /> - - -- - --------------------- <br /> (Plot plan, showing size of lot, locati o syste in relation to wells, buildings, etc., can be placed on reverse side). <br /> fibR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---------------/-,-- <br /> .` `--------------------------------••-------•---•---- DATE----- <br /> REVIEWEDBY----------------- ---- ---------------------------------------- •------------------------ DATE.----------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED--------------------------------------------------•-----------------•--• •-•-------- --•------------ DATE------------------------------------------------------------ <br /> Alterations and/or recommendations------- ------- ----------------------------------------------------------------------------------••-----•--------------------•-•-------------------------.----- <br /> -------•................-----------•--...------------------•-----•-----------------------•----•------------------••-------------------•--•----------------------------•---------------------------•---------------••---------- <br /> ------- ------------ ----------------------------------------- ---- -- --------------------------------------------------------------------------------------------------------------------------------------------- <br /> FINAL INSPECTION BY:.. - = �-------- Date------------- IV-/.--3- -:-.-�.---- ----------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Strut 300 West Oak Srreet 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED S-59 2M 5-62 ATLAS <br />