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� FOR OFFICE. SE: <br />------------------ --- ------------------- <br /> _.---_----. APPLICATION FOR SANITATION PERMIT Permit No. ..fG . <br />--------------------------- - ------------------------- (Complete in Duplicate) 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. `r <br /> This application is made in compliance with County Ordinance No.­549. ' <br /> t ` ---___k______._......- ............................. <br /> JOB`ADDRESS AND LOCATION---- �-�` .__ / ------------------- --- ----------------•---- <br /> Owner's Name---- -------=•-----------------`=-_-=..----=----- -------_------------. -. - = ------ Phone.---- ..................................---..... <br /> •7J A - -... <br /> --------•------- == <br /> Contractor's Name --- --��-----------------------------------------------..-....-------- ----=---------.. .._. Phone......... <br /> Installation will serve:, Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ---- Number of bedrooms L --- Number of baths J-_-_ Lot size -------------- {� <br /> Water Supply: Public system �ommunity system ❑ Private ❑ Depth To Water Table �_t+ ft: V , <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No B"' New Construction: Yes [Er-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 /> r <br /> Septic Tank: Distance from nearest well_'r -----Distance from foundation-_�0___ _-._-._.Material------------------------------------------------- <br /> [ No. of compartments------ Size______.. _SLiquid depth____._!)'______________Capacity--R.P _c� <br /> �/__._. <br /> Disposal Field: Distance from nearest well._--_------Distance from foundation..64. ..........Distance to nearest lot line___d�j.... <br /> 2T' Number of lines____._-__V"--------------------Length of each line_''$_ ze?r_ <br /> - . .Width of trench.......... <br /> __..3.._._ <br /> Type of filter material._'_J?d.C�____.__Depth of filter material----./_a'_4_____-Total length------------ <br /> fie,, <br /> Seepage Pit: Distance to nearer well----------------------Distance from foundation__I_d._f....__-..Distance to nearest lot line _.__ --�'� <br /> UK Number of pits3_---Lining material--�a_41....Size: Diameter----3c�_`_'._-_-.Depth_-----_-a'.-4`-j_--------_\� <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material__.--.-------.----.---.----_------_- V <br /> ❑ Size: Diameter-------------------------------------Depth---------------------.-•----------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest-we`II_._--_------------------------------------------Distance from nearest building_---_------____-_-_-------___----_--___-. <br /> ❑ Distance to nearest lot line----------------------------- ------ -----------------------------------------------------------• r----•------•----------------------------- <br /> Remodeling and/or repairing (describb):--------------------------------------- -----------------------------------------------------•---- -----------------•---------••----•-•--....--•-------- <br /> -------------------------------­-----------------.----------1-------------------------------------------------------------------•-------------•--•-----•----------..--......-.._..-----------•------•---------------•----- <br /> I <br /> --------------------------------------•------------------------------------------.-------------------------------------------- <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances. State laws, and rules and regulations f t San Joaquin Local Health District. <br /> (Signed) -------------(Owner and/or Contractorl { <br /> (Plot plan, showing size of lot, location of system in relay n to wells, buildings, etc., can(be1eplaced on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY • ------ ----------------•----------------------- DATE-. �----------------------- <br /> - ---=- --- -- - -- <br /> REVIEWEDBY----------•--•-•-------------------------- - - ----------------------------------- -------------------------------------=-- DATE---------------------------------------------•-------------- <br /> BUILDING PERMIT ISSUED `: ------------------------------- DATE. <br /> Alterations and/or recommend tions:------------------- -------------------• --•--------.._�--..... <br /> --------------------- - <br /> 9 <br /> ------------------------------------------------------------- ----:- ------------- -------------------------------------------------------- ,:--...-------------------------------------- ...., <br /> FINAL INSPECTION BY:.-- --- ------------- Date_ -. .......... . . Z------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Strut 300 West Oak Street 124 Sycdmore Street 205 West 91h Strut <br /> Stockton,California Lod],California Manteca,California Tracy,California <br /> ES 9 REVISED 8.58 ZM 5-62 ATLAS <br />