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FOR OFFICE USE <br /> - --------------- ------------- APPLICATION FOR SANITATION PERMIT Permit No, <br /> ------------------------------------------------------- <br /> -------- ---------------------- ----------------- - �-.(Complete in Duplicate) Date Issued ... <br /> This, Expires I Year From Date Issued <br /> Application is hereby-made to.the,Saii JtiA4 <br /> uin Local Health District for a permit to construct and install the work herein described. <br /> This application°is madb�in compliance with County Ordinance NO". 549. <br /> q-2f-7 <br /> JOB ADDRESS ANDEL f,ef!_Ay.. <br /> CATION./ 9,,e AXIAZ e <br /> _-Are <br /> Owner's Name- 1K <br /> ...............------------------------------------------------------------------------------- Phone.................-•••-----•---- <br /> ----- --- <br /> ............---------- ---*-----------------------*------------------------------------------------------------------------*----------------------- <br /> Contractor's Name...___.___ <br /> - -----------------------------------------------------------I................. Phone..-.............................. <br /> Installation will serve: Residence �Aparfm.ent House [-] Commercial E] Trailer Court [j 'Motel <br /> Number of living units: --pf <br /> Number of 1�aclrooms S. Number of baths I--- Lot size -- <br /> - -------------------- <br /> Water Supply: Public system [3 Community system' ,E] Private 03"'Septh To Water Table Af f t. <br /> Character of soil to a depth of 3 feet: Send E] Gravel.[] Sandy Loam [] Clay Loam E] Clay [] Adobe 2T**`Harc1oan ], <br /> Previous Application Made: (If yei,clote--------------------) No []\ New Construction: Yes El No [] FHA/VX Yes [] No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Sepfic,Tanlsty�- Distance from nearest well------11---------Distance from' foundation--------------------Material------------------------------------------------- <br /> Owl I I <br /> No. of compartments----------------I----------Size------------------------------Li uid depth-----------------------_ <br /> Capacity---------------- ...... <br /> Disposal Figld.-: Distance from nearest well-------- Distance from foundation----------------_-Distance to nearest lot line.._-.._____...... <br /> f457(4� Number of lines------------------------ Length of each line'-:---------------------------Width of trench----------------------------------- <br /> Type of filter material-----------_-------1-----Depth of filter materiel-----------------------Total length___.....-__________------___-------------- <br /> /46,9" 1.? . IIf-., <br /> Seepage Pit: Distance to nearest well---//0--------Distance fro foundation___Ae.`0.......Distance to nearest lot line- <br /> Number of pits-4---- "'-Ael'---Size: I&----- Depth_' le------------ <br /> ------------Lining material_,006�_%io Dia,meter---�KA----- ��________-___----_ <br /> Cesspool: Distance from nearesf�well-_.... ---------Distance from foundation.-------------------Lining material__________________________ __ <br /> ❑ Size: Diameter---------------------- t -----------Depth----------------------------------------------- Capacity-------•--•-----------------gals. <br /> Privy: Distance from nearest well-:---------------------------------------------Distance from ne rdo building_____-__--______________-...__.__-._.__._. <br /> 0 Distance to nearest lot line---__________ <br /> -- -- -------•-----•--I --------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):____--_____'______- .......... <br /> A 0/ ------ <br /> ------------------ ........................ <br /> ----------------------------------------------------------------I------- <br /> ---------------------- ---------- •---------------•------417-------------------------------------------------------------------- <br /> ---------•-------•-------------•-------•-•---------------•------------------------------------------------------------------*------------------------------------------- --------------------------------------------------- <br /> --------------------------------------------------------------------------I--------------------------- -----------_----------7 -----------------------__________________________________________________________ <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, an rules and regulations of the San Joaquin Local Health District. <br /> ------------------- ------------- <br /> (Signed).............. Ne� ------------- ------------------:(��r Contractor) <br /> -,or, <br /> By:----------------------- ---------- <br /> on to w <br /> (Plot plan, showing size of lot, location of system in r ells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.----V -------------------------I-----------------------------.. DATE.... <br /> REVIEWEDBY---------------------------- -- ------------------------------------------------------------------------------ DATE <br /> ------------ <br /> BUILDING PERMIT ISSUED------------------------------------------------------------­--------------------------------------- DATE <br /> Alterations and/or recommencr, tions___________________------------- <br /> ......... ... ------------ <br /> -- -- - --------- -- _A_ ']­ . -f---------- <br /> ----------I---------------------------------------------------------------------------------- ------------------------------------........------------ -----------------------------V <br /> ---------------------------------------------- ------------------------------------------------------I-------------------------------------------------------------------------------------------------------------------- <br /> -------------- --------------------------------------- --------------------- -------------------------------I------------------------------------------------------------------------------------------------------ <br /> FINAL INSPECTION BY:...._.__. = Date------ <br /> (/SAN JOAQUIN LOCAL-.,HEALTH DIST'RI6 <br /> 130 South American Street 300 Wes t,6qk Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California <br /> Lodi,Californld--- Manteca,California Tracy,California <br /> ES 9 REVISE[) B-59 2M 5-62 ATL-A5 <br />