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rvRvrn�.c u�c; <br /> ---------------------------------------------------- <br />------------------------------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. _.._�.�...�C�. <br /> (Complete in Duplicate) it " I` I!-.tv`•i 1i • > � v <br /> 1�° 1 (, <br />----------------------------------------- <br /> This Permit Expires 1 Year From Date Issued` Issued ...........�.T,... <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 Ordinance No. 549. 400wp- ,,.i:• <br /> JOB ADDRESS A,&LOCATIO ...... ---a; .. . . -----••. x� <br /> - ----------- ---- <br /> Owner's Name L� S Phone <br /> �p . -----•------------ ---------------•----_--------------•--- ----•------ ------------...---- •-- <br /> Address_ �.�..... . ----------- ----------------- <br /> Contractor's Name---------- Dom....-----• ..... -- ------------------ Phone................................ <br /> lnstallation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other X <br /> Number of living units: ........ Number of bedrooms -------- Number of baths ........ Lot size _________________�_G©-. `_.,�_ - ----•-_-__-. <br /> Water Supply: Public system ❑ Community system ❑ Private Ix Depth to Water Table ,2-4 ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam A Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date____________________) No K New Construction: Yes No E] 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 well...(p.. --..Distance fro oun�tion___ .�........_.Ma eripl_ ..._.... <br /> ..... .. <br /> No. of compartments___�Y________-_--.Size_-�_x_. _.-._.5.._..Liquid depth...... ---____Capacity �._.. <br /> p +v -�0...- <br /> Disposal Field: Distance from nearest well_-_f7O-____Distance from foundation .._. ____-Distance to nearest lot lied f <br /> Number of lines---------)------_- � <br /> __-_- Length of each line...... .._.(�___. t-'-'Width of trench. 2--- <br /> Type <br /> _.... <br /> Type of filter material._.a5_____.Depth of filter Material_ ____-�• ------Total length______-. -------------____ <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 /> El Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity--------------------.._.__..gals. <br /> Privy: Distance from nearest well_______________________________________ ______Distance from nearest building----------------------------------------- <br /> 171 Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- <br /> t <br /> r t <br /> RemodelingAe r repairing (describ I ____ -- - -- --- -- - -- --- <br /> --- ------ .4g.__...�...- `-_-- <br /> ' � r -•-------•-•--•---------------------•-------•--•--•---••----- <br /> �t t ,._._.. .......... --------------- -- - ------------------- <br /> I <br /> --- ------- <br /> . -- .. <br /> I hereby certify that I hY.!­­� <br /> (rep Chi cation and that the warrill a done in accordance with S oaquin <br /> ordinances, SRe laws,T <br /> d rul and regulations of the San Joaquin Local Health District. <br /> (Signed) ----------------------------------------------------------------------------------- •-----(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 /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------------------------------------------------------- ------- --- - <br /> ---------------------- <br /> DATE----------- <br /> ---------- <br /> REVIEWEDBY-------------------------------------------•- ----------------------------- ---- - --- --- --- - . DATE--------- ..__ ' ..r <br /> - <br /> BUILDING PERMIT ISSUED-- DAVE e---- ----- <br /> -------------- <br /> Alterations <br /> --- ------------•----- <br /> Alterationsand/or recommendations:---- --•---- ----------------------------------------•-•-•------------------.-.......--------••-••---------••--•--•--------•------••-•----•-•----..__._.. <br /> ----.---•---•-----•----------------------------------•-------------------------------------------------------------........-----------------------.--.--------------•----------.---------------------.---------------------- <br /> •----.-----•----------------------•------------•-••-------•--•------------- <br /> FINAL INSPECTION 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 /> EB 9 REVI9EO 19.69 7M 5-61 ATLAS <br />