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FUKUFFICE U E: <br /> _ <br /> APPLICATION FOR SANITATION PERMIT Permit No. ....!__ _____. �., <br /> ... = --- ---- --- --------- (Complete in Duplicate) <br /> - - - This Permit Expires 1 Year From <br /> Date Issued Date Issued <br /> t C33va _o <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct a Install the work herei described. <br /> This application is made in,compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LO TION............. . .. . •-- <br /> Owner's Name--------f•. --- •=----------- ------ -- Phone--•--- - --•- <br /> Address----- � --- ----------------------------•------------- ••-------------.............. °�+............. <br /> y <br /> Contractor's Name----------- -----------------------------------------••----....-------•-------------------------------- Phone................................... <br /> Installation will serve: Residence [!?Xpartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ./_. Number of bedrooms ___7---IClumber of baths ./__- Lot size ................. <br /> Water,;Supply: Public system ❑ Community system E] Private [. �'6epth to Water Table _2,_.J.rTt. <br /> Character of soil to a depth of 3 feet: SandGravel ❑ Sandy Loam 3--Clay Loam ❑ Clay ❑ Adobe❑ Hardpan <br /> Previous Application Made: (If yes,date____________________) No e' New Construction: Yes B—No E] FHA/VA: Yes [:] No [` <br /> • r <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> SAptic Tank: Distance from nearest well---- Distance from foundation------ ...... .......... <br /> No. of compartments----------�.r_..____Size__.._ Liquid depth....------,%r_________capacity.....Z <br /> Disposal Field: Distance from nearest __.Distance from foundation......�,--- e......Distance to nearest lot line-------..?-p � <br /> [� Number of lines------------------_el-----------Length of each line------..------------Width of french.............Y---------.--- <br /> Type of filter material._. r __Depth of filter material______-________:__Total length_________________ r- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation................._-.Distance to nearest lot line__---___-__------ h <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth---------------------------.-. - <br /> I- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material..------------............_.___.___- <br /> ' ❑ Size:"D;iameter------ 6---------------------------Depth---•-----------•-------•---•----------------------- Liquid Capacity-----•----------•-------_-gals. <br /> Priv Distance .from nearest well___________________________________ __._Distance from nearest buildin .-.-----_.....__.._. <br /> Distance„to nearest lot line-------------------------------------------------------------------------•-------•-•-------..._.:--••----•---....---------------------------- <br /> 4 Remodeling and/or repairing (describe)---------- ---------------------------------------------------------------------------------------------------------•--------------....---------......... <br /> i- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------••-------......----•------------------------ <br /> _:. ---------------------------------------------------------------------------------------------------------------------•--------•-•------------•-•----------------------------------------------------------------------------- <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 /> ordinanc/Sflaws, and rules a �ulafions of the San Joaquin Local Health District. <br /> (Signed). •`•..''Gr. -­---------------------• ---------•--------------------------------------------------------------(Owner and/or Contractor) <br /> By:.........--.........................................._-------------•-----`-----•-------•----...._._....... (Title)_ <br /> (Plot plan, showing size of lot, location of system in;relation to wells, buildings, etc., can be placed on reverse side). <br /> FO EPARTMENT USE ONLY <br /> APPLICATION ACCEPTED SY------- ° <'',--------------------------------------------- DATE------------- ra ---�'---------- <br /> REVIEWED BY = = ='------------------ DATE-------.----------------.---------•----••------------------ <br /> BUILDING PERMIT ISSUED--:---------------------------------” ---- DATE <br /> ANrations and/or recommendations:---------------------------------------------------------------------------------------------••--•----•....----------------- --------------- <br /> .. ------ ----- - --•----------------------------------•---•----------------•---------------•--•-------------------.-_-----------...-----_-------------.----....... <br /> FINAL INSPECTION BY:. = •--------------- <br /> -------------------------- Dete •--?� _ `-'~'.._..------------------------ <br /> SAN JOAQUIN LOCAC14EALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9Th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 9-89 ZM 5-61 ATLAS <br /> 1 <br />