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---� �= �rrlc.t usl� L <br /> rVK -, <br /> __________ ___________________ APPLICATION FOR SANITATION PERMIT Permit No. ...: ........... <br /> --------------------------------------------------------- <br /> (Complete in Duplicate) <br /> This Permit Expires 1 Year From Date Issued Date Issued .'.....:1..'... .� <br /> Application is hereby made to the San Joaquin Local Health District for ermit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 54 <br /> JOB ADDRESS AND AT N... <br /> .. � '. <br /> Owner's Name__-- ----. Phone ---Q _'�.�'Q� <br /> Address",-? --- . ••. --- ------•--:•-.. <br /> Contractor's Name------ ---- --- t.- ,��. .......... tom+--eco-__. rY_ Phone-/ <br /> Installation will serve: Residence Apart nt House ❑ ioumber <br /> mmercial ❑ Trailer Gourt [IMotel [3Other [3Number of living units: --f.. Number of bedrooms of baths _ Lot size <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ........ ft. <br /> Character of soil to a depth of 3 feet. Sand ❑ Gravel ❑ Sandy Loa r K Clay Loam [IClay [IAdobe[:] Hardpan ❑ <br /> Previous Application Made: (if yes,date____________________) No- New Construction: YejAj� 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 /> Sapt�iic Tank: Distance from nearest well_,r._ 'Distance from foundation__1Q___e....Mater' I____ -_ <br /> J� -------------- Y xr.a.._x...�..... <br /> I4o. of compartments__-,�-__.________--_Size�."XI& Liquid depth__.,--'______-_._Capecity_..ZAl <br /> ,. Distance from foundation-_� --____Distance to nearest lot line.... <br /> .._ � .....� <br /> Disposal Field: Distance from nearest well_ :_ � <br /> W <br /> Number of lines____________________________ ____Length of each line..... !- Width of trench---- ..----________.___.._.__ <br /> Type of filter material.- _ p g <br /> -_Qe Depth of flier material..._ _�_________.__TOtal length �.rr_.!--��_.: <br /> Seepage Pit: Distance to nearest well_ -__--.Distance from fo,�fhda#ion...-f ..�....Distance to nearest lot line..._- � <br /> Number of pits_..._______________Lining material �-,_.__.Size: Dia meter_!!l.'.=4.710'Depth____-1,.-�.,-�„-�--. . `�, <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--______....___.____.._-------------- W <br /> ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well------------------------------------------------- from nearest building---._--.-_._________-_-----_-___________-. <br /> ❑ c -- <br /> Distance to nearest lot line---------------------------------------------------- -------- -----•---•------------------------•----•---••----------------------------- <br /> Remodeling>and/or. repairing (describe):,, t --P. ¢��x____ --__ -__ .-_- _, 3„r_-,. - ,,, :•,���, <br /> ---••--••------•--------- •-•------- --•-------•------------•--- <br /> ----------------• ----•----- ---------••••----------------•-- •----•-----------------•---------------------------------------------•----------._.------------------------------ <br /> I hereby certify that I have prep ed this application and hat the work will be done in accordance with San Joaquin Counfy <br /> ordinances, State laws, nd rul gulaf s of ' <br /> hti San aquin Local Health District. <br /> (Signed) - = --- - - --- --_- -----------------------•-- ...---- (Owner and/or Contractor) <br /> By: :....,. -------------------------------------------------------------(rile. :_ <br /> (Plot plan . win ize 'o, locafl n of system in relation to wells, buildings, etc., can be pllced on evAide)�r <br /> f <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY L 1- "'"---------------------- ---------------------------------------- DATE--- L <br /> REVIEWEDBY------------------------------- ------------- -------------------------•------ ----------------------------------------------- DATE-------------------------- <br /> BUILDING PERMIT ISSUED------------------------------------------------------ ---------------------------------••----•--. DATE------------------ - ----------------------- <br /> Alterations and/or recommensfations:_I'? - IS--{v-1-----------{ -- ri 5 '. yy,----- ---••-•- - ,,- , <br /> ---------------------------------------------------------------------- <br /> --------------------------•-•----------------•--------- -•----------------------------------------• --•-----------------------------------------------.-....-------------------------------••--- -------------------------­- <br /> -------- <br /> FINAL INSPECTION BY:..-.-C <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 /> ES 9 REVISED 8-59 21M 5-61 ATLAS <br />