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FOR OF�E U15E: <br />_______________ _--------------------------_----------- APPLICATION FOR SANITATION PERMIT Permit No. ........ <br /> -------------------------------------- --------------- (Complete in Duplicate) �- L <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 work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> 1 I <br /> - <br /> JOB ADDRESSD LOCATION_. , 7�(� ------- .............................................. <br /> Owner's Name-1— <br /> Phone/ - ----••--- <br /> ----- -- ----------------------­--------------------- ------- <br /> `7 ... <br /> Contractor's Name------ . �---��'-----•---•--------•-•----••----------•-----•-------------•r-�� , <br /> -•----•-•---• ---------------------------------------------------- -- ......................... Phone................................... <br /> Installation will serve: Residence ®Apartment House ❑ Commercial ❑ Trailer Court [j—'Motel ❑ Other ❑ <br /> Number of living units: _1____ Number of bedrooms .1--- Number of baths I----- Lot size ___-Z_Pxy;,r�� <br /> Water Supply: Public system 11--6-0mmunity system ❑ Private ❑ Depth to Water Table <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobetj"Aardpan ❑._ <br /> Previous Application Made: (If yes,date--------------_-----) No E�' New Construction: Yes Ul—No ❑ FHA/VA: Yes ❑ No [jl <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet <br /> Septic Tank- Distance from nearest welly-�----Distance from foundation-/a--------------Material--- 1114 ............. <br /> No. of compartments-------2---------------Size--------` -xS` ----Liquid depth__--.{-!_'-.------------Capacity._ <br /> Disposal Field: Distance from nearest well,7Lr74_-._.Distance from foundation_l��. .........Distance to nearest lot line_�/_._... <br /> 2K Number of lines______ �'___w_-_________---__-Length of each liners 0_'-_r�__./6PWidth of french...... . :_y______________ <br /> Type of filter material-_.1 vt4____--___Depth of filter material-----------------------Total length----------1.1Z.?.__________________. . <br /> Seepag Pit: Distance to nearest welL_�---------Distant Pm foundation-.I_Q_ttn":rn..Distance to nearest lot line._51............. 0 <br /> Number of pits----_--- g ------Size: Diameter-_- `- ------.Depth-------X.0 _--_----••--_---- <br /> Cesspool: Distance from nearest well-----I...........Distance from foundation---_----------------Lining material__-___________________________....... <br /> ❑ Size: Diameter---------------------- ---------------Depth---------------•---•--------------------------------Liquid Capacity---------------------------9als. <br /> Privy: Distance from nearest well____________________________________________-----Distance from nearesf building------------------------------------------ <br /> 0 Distance to nearest lot line------------------------------------------------------------------ ---------------•---------•----•---•---_••-------------------------- <br /> Remodelingand/or repairing (describe :--------------------------- ---------•-•-•-•--------•--------------------------•---------........................................................ <br /> ---------------------------------------...............................................----------- <br /> I hereby certify that I have prepared this a lic tion and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulati s o the San Joaquin Local Health District. <br /> (Signed)---------------------------------------------------------- - •----• •-------------------------------------------------------------------- ----.-...---(Owner and/or Contractor) <br /> l > <br /> $y:-------------------------------•---•-•-----•--- ------ ------------ ----•••----------------------------•----..................(Title)---------------------------------------------... --------------- <br /> (Plot plan, showing size of to , ion of#system i relation to wells, buildings, etc., can be placed on reverse side). <br /> +-� FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY- ---- -z - ----- ---=� ------------------••--•- DATE_. _ <br /> REVIEWEDBY_------------------------------------- -----------------------------------------•---------------------------- DATE---------------•---•--------------------------------------- <br /> BUILDINGPERMIT ISSUED--------------------------------------------------------------____--------------------------------- DATE-------------•---•---------------------------•-------------- <br /> Alterations andJor recommenctatio s___ _______________ _____ ____ __________ <br /> ( -- <br /> �• r = <br /> I <br /> FINAL INSPECTION BY- d.--- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Strout 300 West Oak Strout 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracyr California <br /> t6 7 REVISED 9•S9 2M 5-61 ATLAS <br />