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FOROFFICES USE;( <br /> __. -____.__. I APPLICATION t0lkR .SANITATION PERMIT Permit No. _- <br /> -"------- ----------------------------------- <br /> (Complete in Duplicate) <br /> ------------------ <br /> ---------- --- This Permit Expires 1 Year From Date .Issued <br /> Date Issued <br /> Application is hereby made to the San.Joaquin Local Hea)thb sfrict fora permit to construct and install the.work herein described. <br /> This application is made in compliance with County Ordinance N . 549 <br /> JOB ADDRESS AND LOCfATION_)/----` _,---y,.�,u-__ � �- -_ ---_--- <br /> Owner's Name..i "� -l. <br /> _...."" _ <br /> r <br /> Address =s --- <br /> 1. Contractor's Name - . .............. -------- Phone-----••----`--------••--•--- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: ._____±1Number of bedrooms -------- Number of baths __..___. Lot size ___, Q__... ............... <br /> Water Supply: Public system 0 tCommt"'if' system ❑ Private ❑ Depth to Water Table ---- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay❑ Adobe IN Hardpan ❑ <br /> Previous Application Made: (If yes,dafr ____________________) No ❑ New Cbnstruction: 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 /> r k t I <br /> Septic Tank: Distance from nearest well-----5. -_.Distance from foundation__./_�7----------Material.. _ . --.- <br /> No, of compartments .............Size_ _5_..f_I______----Li Liquid de th__...___.Y__� ______Ca aci ay...., � <br /> 9 P• -- P tY...... <br /> Disposal Field: Distance from nearest well --5-0. Distance Deng#h of each f ne atioh.----:1--P--.�___�tante to nearest lot line_-- ... <br /> �. Number of lines-____-- -�.- idth of trench._____�________________________ <br /> Type of filter material...----4t�__Depth of filter rT1ateriaI_' .___ ----Total length..._ --- <br /> Seepage Pit: Distance to nearest well--.------Distance from foundation-----/40.-_.-.Distance to nearest lot line._.....__. <br /> C--&---- Diameter_.__�.3. .0 <br /> Number of pits__.---------I_...___--Lining material-- - Depth_... '------------------ <br /> � I <br /> Cesspool: Distance from:nearest well_________________Distance from foundation-----------.--------Lining material------------------------------------- <br /> El Size: DiameterA-------------------------------------Depth------- --------------------------------------------Liquid Capacity.........-'-----------------gals. <br /> Privy: Distance from .nearest well----------------------------------------------!-_Distance from nearest building ...... :.. <br /> Distance to nearest lot line -•--------------------- ---•-------------•-•----------------•---•------------•--- ..._ <br /> ------------ <br /> Remodeling and/or repairing (describe):---------------------------------------------------------•••-------••--- ---•------•••------•------..._..------------------ <br /> ---------------------- <br /> ------._----••--•-----••-•--••------•--------•---......• • ............... <br /> ' --------...------•.-------•------------........----------=--------•.............................................. <br /> ----------------•----•- <br /> ---------•------•---------•-•-------------------•----- ------- ---------------- .......... •--•----------•------•--------------•------•----••-----•---•--•-----•-------••-----•---••--- <br /> I hereby certify at I have prepared this application hat the work will be done in accordance with San Joaquin County <br /> ordinances, State ws, and rules end etions of t�te a Joaquin Local Health District. <br /> (Signed)--- --- --- ----------- = -(Owner and/or Contractor) <br /> y:-------------------- --- ------------------------ <br /> ----------- -----------------------------------------------•-----------------------------.-•-----------(Title)------- •-----------•------ -------------- - ------------------ <br /> (Plot plan, showing si f lot, location of system in relation to wolfs, buildings, etc., can be placed on reverse side). <br /> f FOR DEPARTMENT USE ONLY / <br /> APPLICATION ACCEPTED BY , DATE ,/ �r� _REVIEWED BY. ---------•---------••----------------- --......._-..... DATE---•------------... <br /> --------------------- <br /> BUILDING PERMIT ISSUED--------------.I----------------------------------------------------------------------- ------------. DATE------------------------- <br /> ./ ` �"•. � --- ---t�-.-1;�--`r'--- `- -=-------->�-------- - •_1�:�.�----------------------- <br /> Alterations and/or recomm ndations _____ _ . ..._ -- --- <br /> ..................-------- ----- <br /> -----<f-•-----•--------------------------- -----------------------------•-------------------------.....------------------------•.--------------=•---------------------- <br /> -------­------------ -----------------------------------• ---------------. ----- .........------------------------•------ ---------------------- -.-----------------'-- •-------- <br /> Date <br /> FfNAL INSPECTION BY ._ <br /> : __G/,4-- � - <br /> r <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 6 Lodi,California Manteca,CaBfornla <br /> ► Tracy,California <br /> ES 4 REVISED S-fig YM S-61 ATLAS <br />