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FOR OFFICE USE: <br /> ---------------:................ .................... <br /> ......................................................... APPLICATION FOR SANITATION PERMIT Permit No. ._. f� 1 <br /> ..................... --•............................... [Coffilplete in Duplicate) <br /> This Permit Expires 1 Year From.Date Issued Dafe Issued -. ��_.__ ►_,3 <br /> App <br /> 1i�a+ion is hereby bj�O�-.- <br /> y inade to the San Joaquin Local Health District for a permit to construct and instal the work herein described. <br /> This application is made in compliance-�rC,ounty Ordinan No. 549.�� $ <br /> ��BiAbD A'N'Cf-LOCATI' .---•- .. .__ •- <br /> -•-• ................... <br /> = <br /> Owner's Name....- -� ! , r Phone.................................... <br /> Address------------- m.� a -7 <br /> -r--•.......... ..___.__.... <br /> -_..... •. <br /> Contractor's Name.......... Y.... .... .�_- •------ ---- .............. <br /> .. Phone................................... <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ -Trailer- Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ...._ Number of bedrooms J. Number f baths .-/... Lot size <br /> Water Supply: Public system ❑ Community system C] Private Depth to Wafer Table 1 ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ CIeY Loam] Clay-O Adobe❑ Hardpan <br /> Previous Application Made: (If yes,date.......�-�:-,.....,) No R] New Construction: Yes ❑ No ® PHA/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 /> 7r7 <br /> 4� , . <br /> Septic Tank: Distance from nearest well...._............Distance'from foundation.....................Material...._................... <br /> _._ <br /> El ..- No. of compartments...................... .Size....__.............._...._._:__.Liquid depth........................._Capacity <br /> ................. <br /> Dispos Field: Distance from nearest well....'- �.�.-Distance from foundation...._J(..t_.�---.Distance to nearest lot line_..�-�.... <br /> Number of lines..............�xx__.._ Length of each line......1.0 1...............Width'of trench......�-,,..._.._...__..„_,. <br /> Type of filter material._.N.�__tr,�.•...Depth of filter material_,---_A'........._Total length....._._/d p......................... <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 /> El Size: Diameter..................._..... Depth----------- - -----------------Liquid Cap*city y .............. <br /> gals. <br /> Distance from nearest well............... .............................Distance from nearest building..................... <br /> .................... <br /> ❑ .. .,.•.'.Distonte to nearest lot line.................................................... - <br /> Remodeling and/or repairing (describe):....... ..a�4 ---� �'- �- _• <br /> ............................. ---------------------•-•--- .._... -----------....•--.................. <br /> .................. .......•---.-----••----•--•-----••---.......--•.....••--.---- <br /> .. .................:......._........i......._......_...................................................... ._....................-----...------ <br /> 1 hereby certify that I have prepared this application and that fhe work will be done in accordance with San Joaquin County <br /> . ordinances, State i ws, and rules and gulations of the San Joa=Localth District. <br /> (Signed) 411-r <br /> - r d OContractor) <br /> By:......... <br /> / <br /> (Titre}....................•--- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings,etc.,can be•pladed'on Averse sid`e).' ” <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- - - -- ---- - -•-- <br /> ........................ <br /> REVIEWED BY......................................................... <br /> •......... <br /> -------------------------------- <br /> -:------------------------ ----.- DATE.---....BUIL . ..... <br /> .................. <br /> DING PERMIT ISSUED.............................................-----------•-• ............... DATE.......- <br /> Alterations and/or recommendations: <br /> ................... ...................................--......................................._............................................................................. <br /> ................................................_............................................................................. ............................ <br /> ...............•.-.-•-.......................................................................................... . <br /> FtNAL INSPECTION By,,,;: ................... Date.. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.11a:elton Ave. 300 West Oak Street 124 Sycamore street 205 West 91h Stroot <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> 95 9 REVIVED A-59 8M 3-'63 F.P.CD. <br /> f I <br />