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FOR OFFICE USE: <br /> 301 �qLA D6-- q-I- <br /> I ­C 1 <br /> ----------- ---------------------------- <br /> , <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> . ... <br /> .. ........ <br /> ----------------- <br /> ------------------------- ------------------------------- (Complete in Duplicate) <br /> ----------------------—---------------------- -------- This Permit Expires I Year From Date Issued Date Issued ...�115_A..... <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Or inance 549. <br /> 6 <br /> ........................ .............. <br /> -6TIPN. <br /> JOB ADDRESS A LOCe ------ ------ -- -- --- ---------------- ..... <br /> Owner's Name----- - . .. . ....7­ -10 -----------­-------------- ................................... Phone-----------------------_- ...... <br /> Address------1;�x----- -- ------ <br /> -—----------- .0........... ................. ............................................................... <br /> Contractor's Name-----------------T-16," . .. .... .. ... ............................................. .................. Phone................................... <br /> Installation will serve: Residence N Apartment House [] Commercial [] Trailer Court C] Motel [] Other 0 <br /> Number of living units: .-/... Number of bedrooms __Z' Number of baths J... Lot size .....—5 IV\ --------------_------ <br /> Water Supply: Public system El Community system Private [j Depth to Water Table /$__ ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam ❑ Clayx Adobe[3 Hardpan 0 <br /> Previous Application Made: (If yes,date---------- ---------) N014 New Construction: Yes No E] FHA/VA: Yes [] N <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public se er is available within 200 feet.) - ---------------- <br /> Septic Tank: Distance from nearest well----------- ---- anc9 f;om foundalt' a rl <br /> ,pn----ka.........M t ..... .. <br /> T <br /> V 2— <br /> q <br /> - *) -Capacity. ..... <br /> No. of compartments-----I---- Liquid depth.___._"T'-- <br /> -------- Size.- <br /> -;--- Distance t Lo <br /> Dis al Field: Distance from nearest well, nce from found afipn. ,,1....Q, is ance to nearest .......... <br /> Number of lines......3.... - ------- _Length of each line ' = Width --------- <br /> ...Width of trench <br /> _? <br /> Type of filter material.2.....................Depth of filter material_.1--..._._.__.Total------ Total length... <br /> Seepage Pit: Distance to nearest w90--------_-_----..-_.-Distance from foug ............Distance to nearest Iaf <br /> Number of pits—Z ....... <br /> Cesspool: Distance from nearest well-----------------Distance from fo6clation--------_---------Lining material..................•................... <br /> 1771 Size: Diameter--------------------------------------Depth........................---------------------------Liquid Capacity........._.7.......-----•..gals. <br /> Privy: Distance from nearest well.................................................Distance from nearest building.-__--..__._......_......_......_.._.._... <br /> 0 Distance to nearest lot line-------------1 - -------- -------------------------------------- <br /> Remodeling and/or repairing (describe):---114_14�e_ _.�__r- <br /> ... .......................... <br /> ............. <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ .......----------------- <br /> ---------------------------------------------------------------------------------------................................................................................................................................. <br /> ----------------------------•.-----------------------------.-.---.-------------------.-----------------------------------------------------.-------.---------.-----------.---------------.------.---------------.----.-------- <br /> I <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 akndegulations of the San Joaquin Local Health District. <br /> (Signed) --------------------------------(Owner and/or Contractor) <br /> -------- - -- -- ---------------------------------------------------------- <br /> By:-----4�,4 ----------------------------------------------------------------------------------------(rifle)----------------------------------------------------------------- <br /> (Plot plan, showing size o of ocation of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY--------------------------------- ----- ............... DATE---------.---•----•••-�-- .. ------------------- <br /> ------ ----- -------- <br /> REVIEWED BY--------------------------------------------------------- DATE----------- -­ ----------- <br /> t ---------------- <br /> BUILDINGPERMIT ISSUED............... ............. DATE.......................................................... <br /> Alterations and/or recommendations: <br /> ---------------------I------------............................................................ ... ... ........ ........ <br /> ---------------- <br /> ---. <br /> . <br /> . <br /> . ---- ------- <br /> ........... ------------ ------- -------------U-------I ----- <br /> ---------------------- <br /> . <br /> .......... ---- -- --- ---------------------------------------------------------- - ----------------------.............................. .. ------- <br /> ---------------1—.............................. ------------------------------------------------------------------------------------------------------------------a..................-- -- .... . <br /> ................... ..............------------------ ..... <br /> ::...... ........... <br /> FINAL INS <br /> PECTION BY:._-------------------- ----- Date-------------------------------------------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH 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 /> ER-9 REVISED 8-39 r.P.00.2M 6-60 <br />