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F , R OFF E USE: <br /> -------------------- <br /> ----- --------- l -- <br /> -------. APPLICATION FOR SANITATION PERMIT Permit No. ...� _.. <br /> --- (Complete in Duplicate) t(� <br /> --------- --- This Permit Ex ires 1 Year From Date Issued Date Issued .__.____:.al_ f_ <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 AND LOCATION......./ �a.�P - - s�.. ----- <br /> Owner's Name-----------• - -- ----------- •--------_-- --------------------------- Phone................._-_---------------- <br /> Contractor's Name........... �_ =--.-. --•----------------- <br /> Installation will serve: ResidenceAr Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: . . . Number of bedrooms , Number of baths ./-___ Lot size .......;7 �,i.-..-_ <br /> - ------------------ <br /> Water Supply: Public system Community system ❑ Priva to ❑ Depth to Water Table 414_.�ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adob4 Hardpan ❑ <br /> Previous Application Made: (if yes,dote--------------------) NOA New Construction: 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 /> - i?ptic ank: Distance from nearest well.................Distance from foundation--------------------material------------..................................... <br /> S� No. of compartments-----------------------•--Size---------.....................Liquid depth_--------------------------Capacity................. <br /> DiSposal Field: Distance from nearest well-----------------Distance from foundation-----------------------Distance to nearest lot line................. <br /> �( Number of lines-----------------------------------Length of each line--.----_-----------_-.....Width of french-----.............................. <br /> Type of filter material________________________Depth of filter material_t=------------------Total length__:____________-_____________-_-____--__-- <br /> F <br /> Seepage Pit: Distance to nearest well__416WIC--_-_Distance- om foundation__ __._:_....Distance to nearest lot line______.__.._ <br /> �r <br /> �'t,�N� Number of pits--------�-----------Lining material- -- ._t2.C,f�__.Size: Diameter---.��.-___-__Depth_.._��SS=--------------- \ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material________-:•-__----------------- <br /> ..._.. <br /> Cl Size: Diameter------------•-------------------------Depth----------------------------------------------------Liquid Capacity---------------------------- <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.....................-__-________________-- <br /> ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------_-•--------•--------------------- <br /> Remodeling and/or repairing (describe _ ,f?._.._-..!c.1� �! <br /> -_r- .. --------------- <br /> -- - <br /> ------•-----------------•---------------•-•V------------------------------------------------------------ ---.----. --...__...----..._..._.......__...-----------•-------•---*---•---------------------------------- <br /> I hereby certify that have pr re is application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Stafe laws r s d re tions of theSoaquin al Health Dis . <br /> (Signed)------------• -• �•-� ' ' ------ -- ----- -- =- ._. Owner and/or Contractor) <br /> By:............................------------.............................. ----• --(Tifle)--- — <br /> (Plot plan, showing size of lot, location of system in r a#i fo wellsildings, etc. an be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- ------ ---------------------------------------------------------------- DATE-- <br /> REVIEWEDBY------_----------------------- - -----------------------------------------------------------------......-------_.... DATE.........------------------------••--•---------------------- <br /> BUILDINGPERMIT ISSUED---------------------------------------------------------------........................------------- DATE------------------------------------------------------------- <br /> Alterations and/or recom nd'ations__________ __ <br /> /­.............................. ------------------------------------------------------------------------------ -----------­.................­ ....... Id <br /> FINAL INSPECTION BY:.. r------ ----------- Date------- /v. l:p.!- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 Wast 9th Stroot <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> EE 9 REVISED 6-99 $M B-61 ATLAS <br />