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� FOR OFFICE;USE{ <br /> APPLICATION FOR SANITATION PERMIT Permit No. ....�__�__/���z_� <br />--------------------------- r------------------- (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 construe and install the work-herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION._r 13-f----Z_, <br /> 2 --------------------------------•---------- ........................... <br /> Owner's Name----------------------- ...... ---------•----------••-------------------- Phone----- ------- <br /> Address---- <br /> --------••------ <br /> Contractor's Name................ "- -----` ---�----,�;----�-----�..�...-:.-•--......-.-. ,._Phohe.....�----........................ <br /> Installation will serve: Residence ®-'Apartment House E] Commercial t[I Trailer Court [3 Motel Other ❑ 3 <br /> • a v 1 ,• I <br /> Number of living units:---/--- Number of bedrooms . - Number of baths __C_ Lot size A .......... <br /> Water Supply: Public system Community system ❑ } Private ❑ Depth to Water Table <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] I Sandy Loam ❑ Clay Loam E] Clay [ .-Adobe,eq< ardpan ❑ <br /> Previous Application Made: (If yes,date----------.------p.) No New Construction: Yes ❑ No r 'FHA/VA� Yes❑ No 4;.— <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: r � <br /> (No septic tank or cesspool permitted if public sewer is available within .200 feet.) <br /> Septic Tank: < � <br /> Distance from nearest well_______ _______ Distance .from fo,ndation__-_-----___-------.Ma#aria)_---__....___-:.k'.'_-4 f� ....... <br /> CI fAl� No. of compartments--------------------------Sizer--�'---- Liquid depth--- "`- --------•--Capacity: ............ <br /> Disposal Field: Distance from nearest well _�--------Distance from foundation_.----_ 1 <br /> p - ,�- _.__-Dis#ante to nearest lot <br /> ®� Number of lines--------- ----- ---------------Length of each line----- R---------- Wrdth of trench._,A:!-_------------------•--- ' <br /> Type of filter material Depth of filter material-----, ----Total length...,SE.!------------------------ <br /> Seepage Pit: Distance to nearest well----------_-_---Distance from foundation-.___f�__._-/&Of? <br /> e to nearest lot line../47 <br /> Number of pits-----/-------------Lining material.-/e1.4 _Size: Diame'ter--.. ,' ---........Depth_.v2e7-/-...•-...•-..----_ <br /> Cesspool. Distance from nearest well-----------------Distance from foundation------._-------------.Lining material---------------------_-_-___---_----- <br /> ❑ Size: Diameter-------------.; _-,_._--- Depth_. --------------- '-- Liquid-Capacity---------------------------gals. <br /> Privy: Distance from nearest well-------------------------- ----------------_----Distance from nearest building--------_------_------------------------. <br /> ❑ Distance to nearest lot line------------------ <br /> w <br /> Remodeling and/or repairing (describe): -------------------- ---•----•-------------­-­--.........­­........- <br /> ----------•--------------- •--------•-•-•-------•--••-------------•---•--------•-----•--------- <br /> . l <br /> 3 <br /> I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County <br /> ordinances, State laws, an rules and regulations of the San Joaquin Local Health District. <br /> (Signed) ------------- ---- -- ---- -------------- (fir Contractor) <br /> By:...............--- ------------------------------ ----------------- �� --------------(Title)---------• '----...... -------------- <br /> (Piot plan, showing size of lot, location of;system ' relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR ERA RTMENT.USE_O.NLY / _ <br /> APPLICATION ACCEPTED BY------ -4' - - <br /> - ---------------•----- ---------------------------- DATEj_ --�f--' --- <br /> --&- --------------••---- <br /> -- --- ----- - <br /> -- REVIEWED BY---- ••-----------•• ------- DATE-------•------••----•- - <br /> BUILDING PERMIT ISSUED------------------ ------------------------------------------------------•-- DATE------------------------------------------------............. <br /> ----- <br /> / -'AFterations andfor rec� nd1+ions: <br /> r ----- <br /> 2..,!--- - ------••-•------ <br /> - •-.-... <br /> /--••`..--.f it ;- --•--- ----. C ?`Fw-----'-----------'".f ----- -..-s ..................... <br /> FINAL INSPECTION BY:------ ' u� ---------------- Date--------/..... --------- <br /> SAWJOAQUIN LOCAL HEALTH DISTRICT l 1' <br /> -�fK <br /> 1'30 Soulli Arnvlcan'SfroN 300 Wei k Street? r •- 124 Syeamb7o St 11 405 Wert 9th Street <br /> Stockton,Californiait Lodi,California Manteca,California' Tracy,Califernia <br /> EB 9 REVIBErf 6-39 RM 5-61 ATLAS crT <br />