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FOR OFFICE USE: <br /> ..................••--- --;':.... - --------- <br /> APPLICATION FOR SANITATION PERMIT <br /> .....".................•:=••••...---•----- <br /> Permit No. ---�5��._- I <br /> ... .......................... .................. (Complete in Duplicate) <br /> Dote Issued ___j�__/ <br /> ....•_.. .... _ ............- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to constru t and install the ork erein described. <br /> This application is made in compliance with County Ordinance No. 549. A,dd j <br /> J DDRESS AnD LO TION.. ..-.. --K..-.. <br /> Owner's Name ........ .."..".".-...-.. ."... ----•...... Phone., &.�-•.!- .� d <br /> Address.-- .7 ...t ..�.1�.. ..... _... �7 <br /> /��- ------------------------•--.....Contractor's Name..-Neme_.- �--------- -c�,:..r�.:�-u.•roc,a...................................•---- <br /> Phone......•--._..."_._....----•------•• O , <br /> Installation will serve: Residence Apartment House ❑ Commercial Trailer Court ❑ Mate) ❑ Other ❑ <br /> Number of living units: Number Number of bedrooms -..umber baths ........ Lot size -""... ...._"..-.". -- ------ -_---- <br /> Water Supply : Public system [I Community system El Private Depth To Water Table'9,6_ ft. �1 } <br /> f 3 feet: Sand Gravel Sandy Loam❑ Clay Loam Clay ❑ Adobe❑ Hardpan ❑ <br /> Character of soil to a depth o ❑ ❑ , <br /> Previous Application Made: (If yes,date....... ............) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No <br /> TYPE SOF INSTALLATION AND SPECIFICATIONS: _ f <br /> r (No septic tank or cesspool permitted if public sewer is available within.200 feet.) <br /> Septic Tank: Distance from nearest ......Distanco from foundation....3"°..........Material--- <br /> No ' <br /> . of compartments ....-.Size- ---r.._.?'-:.. �- ---.....---Liquid depth"-••.•�----.-..'-........"Capacity.��"(/� ..... <br /> rq - .1rf--�. <br /> t 0� l �_�_.__._";Distance to nearest lot I Disposal Field: Distance from nearest well.G....-.."..".Distance from foundatio <br /> Number of lines-.".-../"- ..".- .. -.-._."-. Length of.each line--- :��t'.77 .- Width of trench.-2- 1 <br /> Type of filter materia� --Depth of filter materiol..1 �_-..".... Total length-....;?""".. "i......""-"-..........I <br /> =R Segp a Pit: Distance to nearest ell-,-_.-j"0"a.-.--.Distance from,f undation...l_�'_-_...._...Distance to nearest lot line............. <br /> 4� <br /> _ Size: Diameti:r:`:."-- v Depth--.j' -.'S.r <br /> Lining material__/"CA__" - "-" I <br /> t Number of pits...-•-- -.... <br /> r Cesspool: Distance from nearest well.............-_.-Distance from foundation..-."..-"--.-.......Lining material..................................... <br /> ` <br /> Size: Diameter----- ............... ----.. . ------Depth------------------------------------------ _..__Liquid Capacity/-_---------- ---------gal . <br /> ❑ 1 <br /> Pirivy: Distance from nearest well .- .--------............................. .Distance from nearest building"--,I............................... <br /> `❑ Distance to nearest lot line ._..... ........................----••----- -....- ... _ I <br /> 1 <br /> ingan /'or repairing (describe-----------------------------------•.............._._....--------....-------•........"".".....--•--------•...." --------•...._._....._--•----•----... <br /> L ------------------......................................... -.--..-"."""_.". .......................-___-...__.__....-.. <br /> - .--"------------------......__...... <br /> I <br /> - r <br /> .---•----------------•-----------•--------------"----•"-----------.....------.....-----...---------------- ... ---------- •----- <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 s and regulations of t e San Joaquin Local Health District. <br /> 5i ned <br /> ......(Owner end/or Contractor 1 <br /> . / — (rtle) 1 ..................... <br /> .--.-••... .... 1 <br /> BY-------------•-- "- ; <br /> ,. <br /> r (Plot plan, showing size of lot, location of system in relatio o wells, buildings, etc., can be placed on reverse side). , <br /> ,FOR DEPARTMENT USE ONLY <br /> - - <br /> APPLICATION ACCEPTED BY-_- --... "................ <br /> �DATEy <br /> , -----."-..-•------- <br /> REVIEWED BY------------- <br /> DATE <br /> BUILDINGPERMIT ISSUED-------------•--...................................................... ----------------. ...------ DATE..................................................---------- <br /> Alterations and/or recommend'ations:---------------..........-............ .......................... ---•--•---.....-........"......------------•----•.........".-..._........... <br /> 4 -------------------------------------------------------- <br /> I <br /> ----------- <br /> ------------------------ <br /> -------------------- <br /> •--------------------- <br /> . <br /> ..........................."........------...__.._..._._.._._........-•••------- ----- <br /> FINALINSPECTION BY: ..--- ---- - .......................... Date.. ..... '-....Z`_...-..-_-................-•-••.................. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 121 Sycamore Street 205 West 91h Street <br /> Stocklon,Colltomia Lodi,California Manteca,califemia Tracy,California <br /> ES 9 REVISED B-59 LM 5-62 ATLAS <br />