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t'UK Ul-1-IC.t USE: <br /> --------------------------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> f <br /> --------------------- --------------------------- (Complete in Duplicate) �/ y <br /> This Permit Expires 1 Year From Date Issued Date Issued ........�.�:..�.: <br /> Application is hereby made to the San Joaquin Local Health District for a permit to constructand install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION.A._i _ Sr -_._6' -/Y -•-•-•----• _C7tJ u,._, .q� cL.-----..__ ..._ ' i <br /> Owner's Name----- 6 -------- <br /> ` --•------------ ------- Phone_. N..............._......._. <br /> Address........ o <br /> _.. <br /> --------------- K �%•---- . -............................... <br /> Contractor's Name.._ ----------- +! G ......_.. Phone.... -- .�. r. <br /> Installation will serve: Residence Apartment House E] Commercial E] Trailer Court E] Motel ❑ Other ❑ <br /> Number of living units: .../... Number of bedrooms __ Number of baths _P__ Lot size ----- <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water T le .._..... f <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Af Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ ' <br /> Previous Application Made: (If yes,date--------------------) N0 New 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 nk: Distance from nearest well----XP___..Distance from foundation._..LL__._____--Mate`al-----__ _________ ...............or <br /> No. of compartments___-. ________-_Sizey-A..9,�-�__�-A..Liquid depth_.__/__ ____________Capecity 3-Od <br /> Disposal Field: Distance from nearest w ll__, 0---..._Distance from foundation___ <br /> p � 1Q__�......Dlstante to nearest lot line---►�.�__..... <br /> [G� Number of lines----------_-- --------- <br /> --------LOr <br /> ength of each line______1�_a-7 _____.Width of trench________ Z <br /> Type of filter material__.-�L -------Depth of filter material_____-/$_.-.-_.____Total length____......�AA--�.__.__•._______•- <br /> Seepage Pit: Distance to nearest well------------------- ---Distance from foundation................___.Distance to nearest lot line_--.--__.-_--____ <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter---------..------------Depth--------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------.----.Lining material--------------_...................... <br /> ❑ Size: Diameter--------------------------------------Depth--:------•-----------------•------------------------Liquid Capacity............................gals. <br /> Privy: Distance from nearest well----------_------------------------------ -------Distance from nearest building-------._____________-_--_____.-_.____.._- <br /> ❑ Distance to nearest lot line---------- <br /> Remodeling and/or repairing (describe):----------L�.fl7t�ukL�lJrc�-_--__ -__-_-- - -------------- • <br /> , <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, S to laws, and rules and regulations of the San Joaquin Local Health District, <br /> {Signed}_ �l - T AA •------ or Contractor) <br /> BY: ---------- -- '--------------------------------(Title))_...-------------------------------•--...__...-- ------- <br /> (Plot plan, showing size of lot, location of system in relatiells buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_-- ----------------••--_-•--- DATE------ '., G._'G__.Z-_----......_ <br /> ----------------------------- --------- <br /> REVIEWEDBY.... --------------------------------••-------------------------------------------••----------------------------------..... DATE................... <br /> BUILDING PERMIT ISSUED--------------------------------------------------------------- ­--------.._._. DATE.-------------------•-------------- <br /> AFterations and/or recommendations: ----'-------- ---•----------------•--- •-- ------------------------------------------------------I---------•----- <br /> R <br /> ----------------------------------------------------------__________________________tia------._________.________-----_-_{-___________----_-­-------------------------- ------­*.....*------- <br /> ___............___.__._________.......____...___... <br /> ----------_--------------------------------------_..............................._____________r__.-_______-_______.______-___--_...______..________-_--------_.____-___.a_-__.....__..___--_____.__......_____-.--_.______.__ <br /> ____________________________________ '- I <br /> ------------------------ <br /> --------------------------_.........._-----_---,-.________--__________. <br /> _______________________________________________________________ <br /> FINAL INSPECTION BY:411o,1. - -- J <br /> --- Date <br /> -- ------------- / , 1 <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 /> ES 9 REVISED 13.99 2M 35-61 ATLAS <br />