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FOR O-- - - FF10E USE: <br /> ----------------- -'--------- �] <br /> ---------------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. ... _ ../...J <br />-------------• ------- --------- -------------------- [Complete in Duplicate} l/Z y 7� <br /> -----------________ ___ This Permit Expires 1 Year From Date Issued Date Issued -__.___.....,__..._ <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the wor hherein de crbed. <br /> This application is made in compliawith County Ordinance No. 549. <br /> nt f'� I <br /> J08 DRESS AND LOCATiDN f LrL" ....._2�. 4> o--- � ... IBe&....RD.:-------- �! p <br /> Owner's Name. ,..__ Phone.............__------------------- <br /> - rt <br /> 1 ?qM !-T-.�-� ----' = <br /> Address------1--��-�-•--=--•-•�------ -------------- <br /> Contractors Name____M �T��{�:...... �'T! .. � \�C_� Phone <br /> -------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ..___ Number of bedrooms _-`Z,__. Number of baths .2. Lot size .� x.l����a---- ••--•--•--•-•---- <br /> Water Supply: Public system 0 Community system ❑ Private [Depth To Water Table � . ft. <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-------------------_1 No I/ New Construction: Yes ff'�'No ❑ FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> - <br /> =(No--septic-tank or cesspool permitted if public sewer is available within 200 feet.) _ - - -^--- <br /> Septic T k: Distance from nearest well-.�Q___Distance from foundation__._._ ._ _._ - "�ti------- ------- <br /> f�__._..Materlal..���� E <br /> No. of compartment's___.__._.________________Size.X___X_ X ..Liquid depth-------- -----------Capacity.��� <br /> Disposal Field: Distance from nearest well---- .__Distance from foundation..../.©.-------Distance to nearest loft line-i_�.........- <br /> [ Number of lines__________ __ _ Length.of each line_._____ ! ___ -Width oftrench-----.Irkb--0. � <br /> ,Ir <br /> Type of filter material._•__51_9_��__Depth of filter material..___ ______..-Total length _ <br /> _____ _... -------------•--. <br /> Seepage Pit: Distance to nearest well----------------------Distance from,folundation--------------..__..Distance to nearest lot line------------- _._ _0 <br /> k ` �: <br /> F1 Number of pits----------------------Lining material..------------ ± Size: Diameter_------------ ---------Depth-------------------------------- - . <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 building4____----________.._________---.--.----- <br /> ❑ Distance to nearest lot line------------------------- ----------------------•-------.._....-----------------------•-------------------•--------•------- <br /> ---------------- <br /> r <br /> r - i <br /> Remodeling and/or repairing (describe):-------------------------------------------•-------f�-`- '_... <br /> ----- ti <br /> ------••-•--•--••--------------•-•-•----------. -----------------�•-�----- -•----•-••---•------------•-----------•-------•-•---------------•----------•-- <br /> --•-------------------=----------------•--------•------••- -------------------_---------•---------------- <br /> ry. I hereby certify that I have pr red this application and that the work.will be.done in accordance with San Joaquin County <br /> �. ordinances, St a laws, and s d regul ions of the San Joaquin Local Health District. <br /> [Owner an <br /> Contractor} <br /> (Signed) ��--- --- - ----- -----•- - i <br /> ---------------------------------------------------------------------(Title)------------------- - ---- <br /> ,[Plot.plan, showing size of lot,, ocation.of.system in.relation,to wells, buildings,,etc., can be placed on reverse side}. <br /> FOR DEPARTMENT USE ONLY' <br /> t APPLICATION ACCEPTED BY-------•---4 --R I.3 _ ----------------------------------------------------------------- DATE------- '--�-----`---(----­--------------- <br /> REVIEWEDBY----------------------------------------------- ----- ------------- DATE-...--.------------------------ ----------------.----------- <br /> BUILDINGPERMIT ISSUED--------------------------------------------------------------- ----------------------- DATE--------•---------------------------------------------••----- <br /> r Alterations and/or recommencrations:---------------------------------------------------------------•-------•--------•-•------_-•.........................•-........--------..--------•-------- <br /> --------------------------------------- <br /> ----­------------------- <br /> -------­--------- <br /> -----------------------------------------••-----•-------------•---------------------- <br /> ------------------ <br /> v <br /> _____________________________________________________ <br /> \ L 60 Z - - <br /> FINAL INSPECI`F0 Date R-.` <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Srreet 124 Sycamore Street 305 West 9th Street <br /> Stockton,California Lodi,California Mantecar California Tracy,California <br /> d <br /> r <br /> E5 9 REVISED B-59 2M 5-62 ATLAS { <br />