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I R <br /> Aw---------Zh <br /> F;`It APPLICATION FOR SANITATION PERMIT Permit No. <br /> --------------------------- Date Issued ----- <br />------------------------- (Complete in Duplicate) <br />------------------------- ----------------------------- This Permit Expires I 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. <br /> This <br /> application is made in compliance with County Ordinance No..5W_ <br /> ------------- <br /> ............................... ---­------------------­ <br /> ---------------- <br /> JOB ADDRESS AND <br /> LOCATION-_ -- — ---�,- -_---- <br /> Owner's Name--- - --------------- <br /> ------- Phone: <br /> Address- . .. ------- Y------ ­ ----_--------------_------------------------------ <br /> - <br /> Contractor's Name-------------- ............. ------------------------------------------------------- Phone----------------------------------- <br /> 1W --&W <br /> Installation will) serve: Residence Z3,"Apartment House C1 Commercial ❑ Trailer Court€-D Motel 0 Other [I <br /> Number of living units: -./-- Number of bedrooms a_ Number of baths --/-- Lot size ---------------------------- <br /> Water Supply: Public system gy--Community system 0 Private F­l Depth To Water Table Ot7- ft. <br /> Character of soil to a depth of 3 feet: I Sand [] Gravel C3 Sandy Loam [3 Clay Loam ED Clay C1 Adobe g]-`gardpan C1 <br /> Previous Application Made: (If yes,clate-------- -----------) No New Construction: Yes E] No gj-"_FHA/VA; Yes E] No E' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Se is Tank: ) Distance from near!est well_________________Distance from foundation-------------------Material------------------------------------------------ <br /> A(I 5fl4y No. of compartments--------------- ----------Size--------------------------------Liquid depth---------------- ------Capacity-----------_-_------- <br /> Disposal Field: Distance from nearest well.__..--_______._Distance from foundation------------_-----Distance to nearest lot line____.....__----.- <br /> A Number of lines-----------------------------------Length of each line---------------------_------Width of trench----------------------------------- <br /> Type of filter material-------------------------Depth of filter material----•------------------Total length---------------.-. ---.---------.....---- O <br /> Seepage <br /> ength----------------­------------- <br /> Seepage Pit: Distance to nearest well.......-----------Distance from foundation_4?P---------Qu- tance to nearest lot line-Ze--------- <br /> W�- - Depth- --------------- <br /> Number of pits-------V------------Lining material__�&_,/ ----Size: Diameter-- -_-----_ <br /> Cesspool- Distance from nearest well-----------------Distance from foundation--------------------Lining material_______________________________--__ <br /> 1­1 Size: Diameter-----1.`------------------- ----------Depth----------------------------------------------------Liquid Capacity • <br /> Distance from nearI est well--------------------------------------------- Disfance.from nearest building------------------------------------------ <br /> Distance to nearest lot line--------- ----------------------- ...........------------------------------------------------- ...... <br /> ❑ -------- <br /> - -------- <br /> __ ff <br /> Remodeling and/or repairing (describe):------ ---------------------------------------------------------------- <br /> ----------- <br /> ------------- <br /> .....................I----------------------------------------------------------------------------------------------------------------- ....... --------------------------------------------------------------------- <br /> 1 ­1------------------------------------------------------------------------------&------------------------- <br /> ------------------------------- ----------------­---7-l'i----------------------------------------------- ...........1-1------------------------- <br /> ­-----------------------------------------------------------------I----------------- ------------------------------------------------------------- ------------------- <br /> I hereby certify that I have prep;red this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, regulations of the San Joaquin Local Health District. <br /> laws, and nd ------ <br /> __#D=R;E:MWor Contractor) <br /> (Signed)--------------------------- ­ --------- <br /> BY:------------------_---............ ----------------------------------- ------(Title) --- ------------ <br /> (Plot plan, showing size of lot, location of system in rel n to wells, buildings. etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> ---------- ------- ----------­-------- <br /> APPLICATION ACCEPTED BY------------------------------------------------ DATE_.----------------------------- <br /> REVIEWEDBY------------------------- ....I-----------------------------------------------------------------------_---------­ DATE--------------------------------------- ------------------•- <br /> 1 BUILDING PERMIT <br /> er <br /> � - - ISSU-E--D---------------------------------------------I------------------------------------------------ --------- -- ---------"---------------'-*-DATE--------------------• <br /> ATE---------------------.-.-.-.-.-.-.-.-.-..-.-.-.-.-&.-.-.--.-.-j.-.-.-.­......-.-.-.-.--.--.--.--.--.- <br /> - <br /> (ions and/or race mnen a I - . ---- .......... ----- ----- <br /> ----------- ----- ---- -------------------------------- <br /> ------------------------------ ---------------------------------k--------------------------------- -------------- ----------------------------------------------------------------------------------------------------------- <br /> ----------­---------I-------------- --------------------------:-------------------------------------­---------------------------------------------------------------------- --------------- ----------------------------- <br /> Date------ ------------------------ <br /> -- <br /> FINAL INSPECTION BY:._....... .. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak S?ro*t 124 Sycamore Street 205 West 90h Street <br /> Stocktonr California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-$9 2M 5-62 ATLAS <br />