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1-UKUri-IC-EtUSE: <br /> s _ __ r' ' ...-.---- <br /> -------------------------------------------- <br /> .- <br /> .-`_ ..__.____- APPLICATION FOR SANITATION PERMIT Permit No. ��U•�'.'�..... <br /> --- <br /> r <br />---------------------------- --------------------------- (Complete in Duplicate) 11 a L <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 construct and install the work herein described. <br /> This application is made in compliance with County O dinance No. 549. <br /> JOB ADDRESS AND LOCATION—. 4 I <br /> R <br /> -- -- ---`•- -- - ------------ ------------- ` -Cis.°:� a�-.._.� ..t--------•---------------•------------ <br /> Name._._1�,......hx.. rl - - - ----------------------------------------- <br /> Owner'sPhone. p.-- - ..� <br /> ft <br /> Address_.. J 4 ----' <br /> Contractor's Name----- �. �g't-E ........... --------- ------------------------------------- Phone................................... <br /> Installation will serve: Residence a Apartment House ❑5 Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: '_I*_.- Number of bedrooshts __Number of baths ___t____ Lot size <br /> Water Supply: Public system ❑ Community system ❑ Private [r}Depth to Water Table YV ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [-I Clay [Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No 2---New Construction: Yes ► o ❑ FHA/VA: Yes [I 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_.1.. r -Duce from foundation------1d------- <br /> Material_ __.___ <br /> 19 No. of compartments_.--------�---------S1ze**S_6z_A_�-r�-----Liquid depth----..-`_-------- ---Capacity_._-.900�1�.. <br /> � 0 <br /> Disposal Field: Distance from nearest well.1,30-_1.1-Distance from foundation----2_fy_....rDistance to nearest lot line................. <br /> Number of lines._..------• ---------- ------•-Length of each line------- -._. _C _.Width of french-------a.-4.f ............ <br /> Type of filter material._-C��._,__._-Depth of filter material...-._�q_.._.._...Total length.-------- T.`._—D _ <br /> Seepage Pit: Distance to nearest well----- Distance from fo}}��ndation.....LO......Distan je to nearest lot line-_ , ..._.. <br /> Number of pits.______�_.__________Lining material_____lSize: Diameter___.. . .______.Depth__..__+- .............. <br /> Cesspool: Distance from nearest well_________________Distance from foundation....................Lining material------------------------------------- <br /> 1771 Size: Diameter--------------------------------------Depth-------------.--------------------------------------Liquid Capacity............................gals. <br /> Privy: Distance from nearest well-----------------------------------------.-_.-Distance from nearest building------------------------------------------ <br /> 0 Distance to nearest lot line <br /> Remodeling and/or repairing (describe):---------------------------------------- _---------------- ----------.....-------•-----•----------------•-•------•--------•-------•-----------._.. <br /> +�:-- <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 l�a s., an r ei and regulations the San Joaquin Local.Health'District: <br /> (Signed) / -------------------------------------------------------------------------------(Owner and/or Contractor) <br /> By------------------------------------- -- - ------:----(Title)-------- <br /> .. ...-.........•------------------------------------•--•-•--------•-----•---•--•- .. .........-•------------ <br /> (Piot plan, showing sire of lot, location of system in relation to wells, buildings, etc.,-can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> . _ <br /> APPLICATION ACCEPTED BY---,3.-_------- ---- - -- ----------- --------------------------------�----- DATE-•---1-5--�-��--- �--�---�-------------- <br /> REVIEWEDBY-----------------------•-----------------. - -----------------------------------------------------------•-----•--------------- DATE------- <br /> BUILDING PERMIT ISSUED-___,------------------------------------ -------------------------------------•--------------- DATE. <br /> Alterations and/or recommendations:------------------------------------------------------------ <br /> ------------------------------------- .------------------------•---- <br /> FINAL INSPECTION BY:.:�j...... Date----I-------------------- <br /> ---2 --------------------------- <br /> SANOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Srroet 124 Sycamore Strut 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED g-69 YM 5.61 ATLAS <br />