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FOR OFFICE USE: <br /> ------•-----------------------------• --------•---- <br /> I APPLICATION FOR SANITATION PERMIT Permit No. __I,_ <br /> --------------------------------------------------------- (Complete in Duplicate) 7 +r� <br /> ---------------------------------------------------- This Permit Expires 1 Year From Date Issued <br /> Dots Issued _._...,/.. .....- <br /> I Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal[the work herein described.This application is made in compliance with County Ordnance No. 549. <br /> J08 ADDRESS.AND LOCATIOIV.a _ �- �Vl----- -' ---- • ----------------------------••---------- <br /> _ / ,�A <br /> Owner's Name--- . ------ l-'_c!1�-:.--- ----�-•----•-------.... ---------------------- Phone.................................... <br /> Address �- <br /> 1 - <br /> Contractor's,Name__. x • •� �f--001---------------------- Phone.......... <br /> -------- -------------- <br /> % <br /> Installation will serve: "Residence [I. Apartment House ❑� Commercial ❑ Trailer Court ❑ Motel (4 Other ❑ <br /> Number of living units: .. __.Number of bedrooms _1___ Number of baths _I___ Lot size ..OAF." __________________________________ <br /> Water Supply:, Public system ❑ Community system ❑ Private® Depth to Water Table'6_0-_ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ® Clay Loam ❑ Cay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes;date--------------------) No rK1 New Construction: Yes 1�3 No ❑ FHA/VA: Yes [],.'No ❑ <br /> 1 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> `_00_septic4ank or cesspool permitted if,public-se'wer-is <br /> Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material................................................. <br /> ❑ No. of compartments------------------- ......Size............... ------------Liquid depth_.._------ ------Capacity----••---............. <br /> Disposal Field:. ," Distance from nearest well---%Z,� ......Distance from foundation.. Distance to nearest lot line .......... <br /> Number of lines ...............Width of trench--�-`I------•-------------- <br /> { ® ___________________Length of each line_____)_ __ _- <br /> __ <br /> Type of filter materlal%+ _ Depth of flier ------- ...-Total length-----j-_!-____________________________ \ <br /> t , <br /> Seepage Pit: Distance to nearest welL_`�A - Distant frorp foundation__JP_'__-_____-Distance to nearest lot Line ► _ .__.. V <br /> y Number of pits=!_3..............Lining-mate rial�0, �----------Size:.Diameter--_/1.'-•_--____Depth__. -S.................... C <br /> Ems' <br /> Cesspool: Distance from nearest well-----------------Distance from foundation____________...._...Lining material..................................... <br /> ❑ Size: Diameter--- ----------------t'----- ------ Depth----------------------------------------------------Liquid Capacity---•--------------• .....gals. <br /> Privy:{ Distance from nearest well_`_______________ ------------------------ <br /> -Dis�ance from nearest buildi' �^ <br /> -•g-----••--------•--•--- --• ------------ - <br /> 9 <br /> � Distance to nearest lot line--------•-•`•--=:,--••_-• •-------------•------•---•--•----_--..._.- <br /> i a <br /> ., r 3 <br /> Remodeling and/or repairing (describe): - -- --------------- <br /> TC7n"t <br /> t1. ------------------------------- -- ---------------___--------••-----•---•-•---_--•--•-•-••---------- <br /> ---------------•-•------•-•--------------------•---------• i-------- r.-.t tri <br /> •------- -_ -_-_-- ---------------------------------II.. •---------••-----•---------------•--•------- <br /> 1 hereby certify that. I have prepared this application and that the work will be done in accordance with San Joaquin County \� <br /> ordinances, State law , a d rules and regul tions of the San Joaquin Local Health District. �] <br /> . <br /> ! (Signed)............. -----•-A -•- ----------------------- --- - -- ---•------•--------- • ••------•----- 4egntraetorl <br /> 1 <br /> �: �By..�_....r�.....�..... _ rt <br /> e - <br /> (Plot plan, showing size of lot, location of syste elation to wells, buildings, etc., can be placed on reverse side). <br /> 1 FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED --------------------- ------------ DATE ' + - •--------------------------- <br /> REVIEWEDBY-------------------------------------------------------------•----------------------------------------------------------------,DATE_--------__-____-------------------------------••-•------ <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------�_�DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:----•------------------------------------------ --------------------------------------------------------------------•------•-•------------------------------- <br /> ..................................•---••---.._._.._...._..._..._.. ................ ------ -------------­----------­-- <br /> t <br /> -------------•-------•------------------------ -------•--•-------------------- -------------------------------------•--------------•----------------------------------------------------------------------=------------- <br /> FINAL INSPECTION BY -- ? ------------------- Date-_- // ---------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,Callfornia Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8.59 YM 5-61 ATLAS <br /> t <br />