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FOR OFFIO�USE <br /> 1 . �._ ._ —� <br /> APPLICATION FOR SANITATION PERMIT Permit No. ... ....... <br /> ------------------------- -------------------------- (Complete in Duplicate) <br /> Date Issued <br /> ______________ This Permit Expires 1 Year From 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 Ordinance No. 549. <br /> JOB ADDRESS A LOCATION_` -- /a____�......... .... ' <br /> �1 / ----------- ---------------- <br /> l. frr_ ¢7 - ------------- Phone <br /> E <br /> Owner's Name---- •--= - <br /> Address--- ....�-._- ��------- ----- - ------------------------­-� ................................................••--------•-•------•-•-----•-••••- <br /> iNContractor's Name ----------•--••---•----•-----••--•----- Phone-------........................... <br /> Installation will serve: Residence Apartment House ❑ Commercial❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __jC_lNumber of bedrooms _X__ Number of baths _1__. Lot size ............. <br /> Water Supply: Public system -Community system ❑ Private ❑ Depth To Water Table _0 ft- <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel F] Sandy Loam E] Clay Loam E] Clay E] Adobe eq-­HardpanC]Previous Application Made: (If yes!date__N...-----------._1 No'Pa"� New Construction: Yes ��Io ❑ FHA/VA: Yes ❑ No Ej--� <br /> TYPE OF INSTALLATION AND SPECIFICA1I6NS:.,,,,. <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ff�� <br /> Septic ank: Distance from nearest wail_ rxl _Distance from foundation_/-O�..._-.____.Matej ------------------ <br /> No. of compartments__..___ ___________Size------ _ _iS-aC_- .Liquid depth----- ------------ <br /> ------Capacity_._. . <br /> J/ <br /> Disposal Field: Distance from nearest well_--_:._____Distance from foundation.-Z�._r-----------Distance to nearest lot Iine.t5____........ <br /> Number of lines_______: _._ ----------Length of each line... _______________Width of trench._94?`'.------------------- <br /> Type of filter material' :L.w-4�t_____.._-Depth of filter matenal___r_�..`..______-Total length--------jho----_____________________ <br /> r <br /> SeepaPit: Distance to nearest well-------."'-___._..__Distanser.fom #oundation_.!?.............Distance to nearest lot <br /> Number of pits------ _--------------Lining material..__ _a.CA----Size: Diameter-....'nearest <br /> Z�--.......-_-________-_. <br /> Cesspool: Distance from nearest wel!-------_---------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):------------------------------------------------------------------- -------••------------------- -----•--------------•--•-••-----------•------•---•----- <br /> . ,l <br /> ---------•-•---------•---------------•-•----------- --------------------------------------------------------------•---------------------------------------------------------------------------- <br /> l <br /> I hereby certify that I have prepared this p ation and that the work will be done in accordance with San Joaquin County <br /> ordinances; State laws, and rules and regula ' ns f the an Joaquin Local Health District. <br /> I--------------- ------ --- -------- ---------------------------------------------------•-----•--------- -- Owner and/or Contractor <br /> (Signed}--------------------------------------------- { � ) <br /> R <br /> By:--------------------------------------- ---- -----------------------------------------------------------------(Title)------------------------------------------------ ---------- <br /> (Plc+ plan, showing size of lot, location of system in relat' n to wells, buildings, etc., can be placed on reverse side}. <br /> DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----I-•--- - -kxAl----------- ----------------------------------------- <br /> DATE------------- ------------------- <br /> REVIEWEDBY...---------------------------------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED-----------------------•---------------------------------------------------------------------------- DATE------------------------------------------------------------- <br /> Alterations a /or r ommendations--------------------------- -------------------------------•----------._...------------- ------------------- <br /> ----------L---------------------------------------------------- ----------------------------------------- <br /> 1 <br /> ------------------------------- ---- .....................--•------ -------------- ---------- -------------------------------------------------------------- -------------- ------------------ <br /> / -� <br /> FINAL INSPECTION BY:- --- --�- ----------- , <br /> --------- ----- ------- - Date.----------- - ------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 So►rlh American Strut 300 West Oak Street 134 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodl,California Manteca,California Tracy,California <br /> _ e <br /> ES 9 REVISED 8.59 2M 5-62 ATLAS <br /> a <br />