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FOR OFFICE USE: <br /> ---------------------------- ----------------- .. <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) / 2-- <br /> Date issued .��._.:. .. �- <br />----------------------------- --------------- --- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San IJoaquin Local Health District for a permit to c? in In a the work herein described. <br /> This application is made.in compliance with County Ordinance No. S49. Z--g.O.-OS }� <br /> JOB ADDRESS AND OCATION--- •------- ------------------------------ ......... --- . --h•_...._..�._. <br /> 10 <br /> Owner's.Name-- --------------—--- -- --------- ---------------------------------------------------- Phone. t2 : <br /> q ----•----._....-•----••- <br /> Address------�k .... ..!__ r <br /> Contractor's Name_. ` ------------------------•---•------------------.....-----------.......------------------------..........----.._. Phone..........---...................... <br /> Installation will serve: Residence M Apartment House ❑ Commercial ❑ Tr ler Court ❑ Motel ❑ Other ❑ <br /> a <br /> Number of living units: ..__-- Number of bedrooms _-.3--. Number of baths __�r Lot size __.l_ ��------__------_..................... F <br /> Water Supply: Public system ❑ Community'system ElPrivate ❑ Depth to Water Table ........ ft. i <br /> Character of soil to A depth of 3 feet! Sand ❑ Gravel ❑`4Sandy Loom❑ Clay Loam n Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made.10f yes,date-----.---. }"No p hew Construction: Yes`❑ No ❑ FHA/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 /> Septic Tank:... Distance from nearest ell__ ~_"--.D_istance from foundation_-10.-'-=----.Material_- ................................... <br /> •�� ry <br /> No. of compartment---- -----------------Size.7__.��-- ¢-. _-_--Liquid depth----y-•--..----_-----_Capacity.. . <br /> Disposal Field: Distance from nearest well-�U�-.--..Distance from foufridation_/:� !.­.' ..-_.Distance to nearest lot line--- ......... <br /> = Number of lines= ��.- ._ ------Length of each line---_40-----------------Width of trench.... --------....__--._- Z <br /> .Type of filter material '_- -- --Depth of filter material.----/__ ----'� Total length_---l-�d... ...................... <br /> it --- . <br /> Seepage Pit: Distance to nearest we t-/�----------Distance from foundation.- -U�_._..'-.Distance to nearest lot line----------------- <br /> Number of pits__h_'�-._-------_-Linin material..-. ___ s <br /> -�' 9 - � -'-----� .Size: Diameter-�- --...° •--------Depth...... ----------- <br /> P }' T • Mining material-----------------------••-•----•---•- <br /> Cess Dol:" Sze Diam{8 nearest well----------------DDB Distance from foundation----- - ______,Li'Liquid Capacity als. �' <br /> ❑ P k q P tY 9 <br /> Privy: Distance from nearest well------------------------------------------------- from nearest building.------------------------_•.-_.----_--.-. <br /> ❑ Distance to nearest lot line--------------------------------------------------------------•-•-----------=----------•----------•---••------------------------------------ <br /> Remodelingand/or repairing (describe)------------------------------------- -------------------------------------------- ...................................................................... <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 rules and'regulations of the San Joaquin Local Health District. <br /> (Signed) --�----- j44Zy1___4J"vtd-----------------------------------------------------------(Owner and/or Contractor) <br /> By: ----------- ---------------------------------------------------------(rtle)---------------------------------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). t4 <br /> 1 FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY- -- - ------ -------------------------------------------------------------- DATE-- P-------- 7L----------------------------- <br /> REVIEWEDBY------------------------------------------------------------------------------- ------------------------------ ............... DATE-----------------------._---------•----•-................ � <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE.------------------------------------------------•--------- <br /> : .. FV I <br /> : ------------------- ------•.-•----... <br /> Alterations and/or recommendations <br /> -----_---•----.......-•-------- ................................ ------------------------------------------- <br /> - <br /> --------------------•-------•------------- -----------------------•-------... -------------------------••-......•-------------------------- ------- --- -•-•--•-•------------ - --- • • <br /> FINAL INSPECTION BY----- --- --------- -- _-- - ------------.-.-....---- Date-----. - ----- <br /> t - '----------------------� <br /> --•--- <br /> SAN AQUIN LOCAL HEALTH DISTRICT <br /> t <br /> 130 South American Street 300 West Oak Street 144 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> E5 9 REVISED 8.99 QM 5-41 ATLAS <br />