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FOR OFFICE USE: <br /> 4 <br /> ..........................._.____..__._-- ------------- APPLICAT[UN FOR SANITATION PERMIT Permit No. __ . ... ✓��� <br /> ----------------------------------• (Complete in Duplicate) <br /> �_ Date Issued' - <br /> .---__.________________F._,_ .;_ This Permit Ex ares 1 Year From Date Issued <br /> Applicetion.is.hert3b'y`made fio.the Sen Joaquin Local Healfh District for a permit to construct and install the work herein described. <br /> This application is-is <br /> ae In compliance with County Ordinance No. 549. <br /> �• � �a to <br /> JOB ADDRESS AND LOCATION----_..Z/2-_V, ------°2 <br /> Owner's Name........ ..... Phone.._---------------_------_--_ <br /> Address--- . <br /> ..... 7_'y! ---------- t --•------------------------------------------•- <br /> Contractor's Name _ ____. _ --------------------------------------------------------- Phone................ <br /> Installation will serve: Residence PP Apartment House ❑ Commercial ❑ 1-railer/Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -1-_-- Number of bedrooms _A___ Number of baths tee. ... Lot size C �_a�I <br /> - ----------------------------------------- <br /> Water Supply: Public system E] Community system ❑# Private 20 Depth to Water Table .O__ ft. <br /> 3 <br /> Character of soil to a depth of 3 feet:' Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam,® Clay 0 Adobe❑ Hardpan M. <br /> Previous Application Made: (If yes,date-------- No ( New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ <br /> 4 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or-cesspool <br /> tiJpermited_if.publices- wer-is.available <br /> within.200-feet: <br /> Septic Tank: Distance <br /> from <br /> narest well-_� _.x___Distance from foundation----6l)___--------- <br /> Mate�r-ial.__ <br /> No ----�-------------Size_ <br /> -.,,,__-.••-._-._-_.-.- <br /> ---Liquid depth P tY f <br /> Disposal Field: Distance from nearest well-.-.b---------Distance from foundation...ii ?0--.__-____Distance to nearest lot line--- <br /> Number of lines_-_�__ ___________Length of each line.....�_S?'b---------------Width of trench e�' �_..._............. <br /> Type of filter materia-�, -De th"of filter material___, t <br /> P -I� f----------Total length--�-----••-+•------------------------ � <br /> # r es <br /> Seepage Pit: Distance to nearest we I__-�41-D--_�=___Distance from oundation....f P.....•.._Distance to nearest lot line__.5........... <br /> Number of pits.... Lining material_____+_Size: Diameter._ � __.........Depth__._. ..___.._____-_---_ <br /> Cesspool Distance from nearest well_____._.___-_--Distance from foundation--------------------Lining material------------------------------------- <br /> El Size: Diameter-------------------------------------Depth--•-•-----------------I-------•---------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well----------_*------------------------------- Distance from nearest building <br /> ❑ -Distance to nearest lot line----------I-----------------------------------------------------------.-------------------------------- -•---•-•------------•-•-------------- <br /> Remodeling and/or repairing (describle)------------------------------------------------------------------------_-_ <br /> f: <br /> ---•-•-----=--------------------I.._.....------. ------ ------------••---••---------------------------•-•----------------•-------•-•-•-------•-------••----------...-..------------------ <br /> ------------------ - -----------------....................; ----------------------------------------•-•--••--------------------•-----••--•-------------•-------------------...---......------------•-------------•- <br /> ---------------------------------------------------­...........4 -------------•------------------------•-•--•••----------------------•----------•-------------•-----•---•-----------•-------•------- ..------------- .-.� <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> r reed _ State laws, and rules and Ire Dos of the San Joaquin Local Health District. <br /> ordinances, <br /> (Signed)} ---------------------------•---•-•---•---------•-----------------(Owner and/or Contractor) <br /> BY: - - = ------- -------------------------------- ----------------------------------- ......(Title).......------------ <br /> "(Pio+plan;showing size of lot loc on-of system in relafian fio wells,'6Uildings,�efccan'be placed on reverse side). <br /> _ FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED yJ J <br /> 'r DATE �s�` ---------- <br /> BY__ <br /> REVIEWEDBY----------•---------------------------= ------------------------------------T=---------------.--------------- ......... DATE---------------- ....... <br /> BUILDING PERMIT ISSUED----------------- --•------------------- f ------••----------- DATE <br /> Alterations and/or recommendations:_?'------------------------------ --- -----------------------------------------------------------------------------•--•----------------•- <br /> f — fl- <br /> ----------------------------------------- -----------------------------------------------•----------------#--:------------------------------------•----------....._...----------------------.....--------•--••••........._... <br /> ----------------------- -----------•--••---------------------------------------------------------------------------------------------.-.._................................------------•-------------------•--------------- ' <br /> i ► <br /> ----------------------------------------- - ............................... ------------------------i--------------------------------------- ----------------------------------------------------•-----------•-------- <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,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 0.59 RM 5-EI ATLAS <br /> _ E <br />