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FOROFFICE USE: <br /> --------------------------------------------------------- <br /> --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------------------ ------------------------------------- (Complete in Duplicate) <br /> -------------- This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND L CATION... 2G��, ��a �n <br /> Owner's Nam -------- <br /> / a t Phone ----------------- <br /> - - �-- ---- <br /> Address.--- -- ------ <br /> Phone. <br /> --------------------•--------------------------_.. .. <br /> Contractor's Name. --f <br /> ---------------------------- ................... <br /> Installation will serve: Residence ent o se Commercial ❑ Trailer Court ❑ ylotel ❑ Other <br /> Number of living units: -1--- Number of bedrooms _-1---- Number of baths --.�_-_ Lot size <br /> -12� ` <br /> ---_ ----------- <br /> Water Supply: Public system ❑ Community system ❑ Private Depth To Water Table. ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel V� Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: llf yes,date--------------------J No4 New Construction: Yes P�( No ❑ FHA/VA: Yes ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewers available within 200 feet.) <br /> Septic Tank: Distance from nearest well _ Mstan a fro . foundation----La-.--.---.Mat r <br /> No. of compartments----.---7 s Caci 'f <br /> Size....-� ----- Liquid depth- F� tY.. > ---?---- <br /> Disposal Field: Distance from neares well-�!ew-A Ice from foundation-_----- °i r�e to nearest tat line---- <br /> _.... <br /> Number of lines------ ---------- Len th of each line-- -_ idTn of ,re c <br /> ota�� .I ngth----•- --.�_... <br /> 9 ._. <br /> Type of filter material._, ��epth of filter material -__ ____.•-_ .� <br /> p Lining <br /> to Depth <br /> lot Eine <br /> Seepage Pit: Distance to nearest well----------------------Distance from found ' ib eter_ _----_---_ <br /> ❑ Number of its----------------------Linin material-----------__.-------- 5i p -_------- 6" <br /> Cesspool: Distance from nearest well-----------------Distance from foundation._-__------.-----..Lining material--..------------------------------- <br /> 10 Size: Diameter Depth - <br /> p --------•-Liquid Capacity---•--------_-- ----------gals. <br /> Privy: Distance from nearest well----------------------------------------- -----_Distance from nearest building-------------------------- ----------- <br /> 0 <br /> .--- ----❑ Distance to nearest lot line \\ <br /> Rem deling a d/pr repairin (d scri <br /> - - --- - - --- <br /> --- <br /> -------------- ----- <br /> -----------------•----------- ---------------- -------------------------------------------------------------------------------- ..........•-------------------- <br /> I hereby certify that I have prepared this application Ind that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and :gul" tio of the n Joa uin Local He Ith District. <br /> �� r <br /> (Signed .... ---- - -----------------------------------------(Owner and/or Contractor) <br /> By:•-•........................-----------------------• -----------------------------------------------------------------••-----------(Title)---•--------------------------------._...---- . ----- <br /> (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY------------------------------------------------------------------------------------•----------- DATE - -- <br /> REVIEWEDBY------------------------------------------------------------ ---- ----- ----- ------- -----•-------------------.- DATE--------- <br /> � —1-4----- <br /> BUILDING PERMIT ISSUED------------------------------------ ----------------------------------- DATE------ ... / ----------- <br /> Alterations and/or recommendations:-------_-------------- ------ --------------------------------------- <br /> --------------­--- <br /> -•----•---------•-•-•-------------•--..... <br /> •-•--•---- ------------------•------------ -------•-•------------••-------------------------- ----------------..-..-----------••------•----------------------------- --------••---•---------------------•- -•---- <br /> --------------•--------------------------------------- <br /> ------------------------------------------------------------------------ <br /> FINAL INSPECTION BY --._. .... -- <br /> - ----- --------- ------------------------------ -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 west Oak Strool 124 Sycamore Street 205 West 41h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> E& 9 REVISED a-59 2M 5-62 ATLAS <br />