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FOR OFFICE US <br /> -_-----� ___! ��-v_. ---. APPLICATION FOR SANITATION PERMIT Permit No. .../...lr�__�]-/_Z <br /> f f <br /> ---------------------- ------•------- (Complete in Duplicate) q <br /> -.--- This Permit Ex fres 1 Year From Date Issued Date Issued ._l__�1.. .... .�--- <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 Ordin ce No. 549. <br /> JOB ADDRESS AND LOCA I N... a1 -� Q ------------------•-----................................................ <br /> Owner's Name--------Ve--. <br /> -------- ------•-•� -- -- - -- --- -- - ------------------------ -- Phone-----•---••----...--••- -----•- <br /> Address.----...---- a �1'�-------- ---- -------------- ----------�'-_'_�` ----------------...------------------------------------------------------------•----------------------------•------- <br /> Contractor's Name------------- --- - -----------------�--- ---- Phone........._.......-•----- <br /> ------ ------ <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of livingunits: _-_ -__ Number of bedrooms _ ..�.g'a--------------------_--- <br /> � �-_. Number of baths .___ Lot size ____.._.�_ <br /> Water Supply: Public system ommunity system ❑ Private UKDepth To Water Table Joi ft- <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No 2r-_`New Construction: Yes nVo ❑ FHA/VA: Yes .No ❑ <br /> TYQ': OF INSTALLATION AND SPECIFICATIONS: <br /> WP (No septic tank or cesspool permitted if public sewer is available within 200 feet.) )l <br /> Septic T Distance from nearest well-5-0-_f--__Distance from foundation./O---r_______.Material--- - <br /> No. of compartments----_-----�---------Si _ze__a"___A. _ - Liquid depth------4.0--------------Capacity....f_�6__ <br /> r � � <br /> Dispos�eld: Distance from nearest well......Distance from foundation...1_1-___________Distance to nearest lot line..d. .....:.... <br /> LeJ Number of lines________._ 7J--* <br /> ---------•-____--Length of each line_-- _____'v-_-----.Width of trench... 4..�r. _..._P.............•--- <br /> Type of filter material.%P'4�1�_-_-Depth of filter material----1,r____-------Total length______/7.v`~6_____________________ <br /> r <br /> Seepage Pit: Distance to nearest well-A-0---- Distance from foundation__- Distance to nearest lot line.. .......___.- <br /> Number of pi#s--.._._� Lining material. CA,-Size: Diameter_.... .__._-...._Depth------- ----If------------ <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 neerest lot line-----------------------------------------------------------------------------------------••-----•----.-----•---------------•---------------- <br /> Remodeling and/or repairing (describe)_---------------------------------------------------------------------------------------------------------------------------------------------------------- <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 /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed) -----Owner and/or Contractor <br /> By:-------------------------------------------- - ------ ---------------------------------------------------4Title)........•--------------------------------------- <br /> (Plot plan, showing size of lot, location of system in rel, ion to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------01 A_­- DATE----- 's --------------- -- <br /> REVIEWEDBY------_------ -----__------- --------------------------------------•------------------------------------------------------ DATE------------------------------------------------------•---- <br /> BUILDING PERMIT ISSUED............----=- ---------------•---•----------------- <br /> _. _ ._ ._ _ . � - -----------.-_---DATE-------------------------------- <br /> Aherattons and/or --------- — ------------------- <br /> ---------O'k-----------------_----------_---..---- ---------------------••-------------a_.97rQ�s------------ <br /> -----------------------------------------------------------------------------=--------------------------- -------------------------------•-------------------------------•-•...........-.------------------------------------ <br /> ----------------------------------- •-- ------ - -- <br /> FINAL INSPECTIONG' �. ------- ----------- -- Date_-----1---- <br /> -----3-`---------------------------------------- <br /> t ---------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Strut 300 West Oak Strut 124 Sycamore Street 205 West 9th Street <br /> Stockton,Colifornia Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED B-59 2M 5-82 ATLAS <br /> a <br />