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UN-1 U <br /> it Jt:------- --- --- -/- ----------- <br /> ................ <br /> ... <br /> ........ -------- -------- APPLICATION FOR SANITATION PERMIT Permit No. ... <br /> ---------------------- --------------- <br /> (Complete in Duplicate) <br /> ---------- 4 Date Issued_- <br /> -------------------- --- ---------- ------ - --- This Permit Ex 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 application is made in-compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND ,tATION....... ........... -------------------- -ee ?44e�-------------- <br /> Owner's Name_______-__ Phone.......................... <br /> --------------------------------------------- <br /> ............................................................................................... <br /> Address.......................... <br /> -- <br /> Contractor's Name_-------- ............. -- ----------------------•.............................................--------------•--•--••-- Phone.............................. <br /> tio 11" <br /> Installa n will serve: Residence Apartment House 0 Commercial E] Trailer Court E] Motel [3 Other 0- <br /> Number of living units: Number of bedroom m*_F___ Number of baths .__Aet size .................................. <br /> Wafer Supply: Public system ❑ Community system 0 Private E] Depth to Water Table ........ ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam ❑ Clay [I Adobe 0 Hardpan C] <br /> Previous Application Made: (.If yes,date------------------._) No ❑ Now Construction: Yes [3 No C] FHA/VA: Yes [I No ❑ <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 well -v42).--i'4-Distance,.4romifoundafi.gn---- _____._.Mat t ' I <br /> .............. <br /> No. of compartments-_ -------------- <br /> ---Sizel� VIYMLiq,icl_clepth----- --- KCapacity---/ 0_-_-- <br /> Dir <br /> apacity.../ e..... <br /> Disposal Field: Distance from nearest well____----Distance from foundation-./ --__Distance to nearest lot line--- <br /> Number of fines_______ ...........dlength of each line__11)0_ Width of trench-_A/---- <br /> 41;0 <br /> Type of filter maferiaf/44,6". epth of filter mater al:. :::--Total len gth____,,0/ ---------------- <br /> See pag P Disf�nce to nearest well----/W--*------Distance from foundation <br /> Distance to nearest I t <br /> Number"of —-----------Lining material___-U ___-Size: Diameter__ �'�..........Depth-- -••--------------------- <br /> Cesspool: DisfanCelo_O_ nearest wall-----------------Distance from foundation--------------------Lining material---------_---- <br /> il ---------------------- <br /> El Size. Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity----------------•---•---...gals. <br /> ...gals. <br /> Privy: Distance from.,,ge'arest well-___________________________ ---.-Distance from nearest building......................-------------------- <br /> El Distance to nearesflo_t�hne------ <br /> I----------------*-----------------------*-----------------I---------- <br /> Remodeling and/or repairing (desc'ribe):--------- %�� .................... --------------- <br /> ------------------------------------------------I----------- -------------------------------------------------------------I-------------------- ................ <br /> -------------------- ­----------­-----------I--------!_.. . I----------------------I--------------------------------------------- <br /> - -----------------------------------------------------*-------------------- ---I-------------------------------------------------------- <br /> --------------------------------------I­-----------------------------------------------------------------------------------------------------------------f <br /> -------------­-------7-------------------------------- <br /> A <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and�regulafions of the San Joaquin Local Health Disfricf. <br /> (Signed)----------------------------- _:n-n <br /> --------------------- - <br /> vim= -=---------I- ---- -- ---- ------------ Contractor) <br /> By:.................. <br /> ---------------------------------------------- ---------(Title)_: <br /> ----------- -- <br /> ------------ -------------- <br /> r . . 'I <br /> (Plot plan, showing size of lot, location' of system i a-frion to ells, b�fld'lhds,Aefc., can be placed.on verse side). <br /> R DEPARTMELT�USE-ONL <br /> 11.�Po I Y — <br /> f / <br /> APPLICATION ACCEPTED B ---------------------- DATE------------ <br /> REVIEWEDBY--------------------------Y--:- --- ---- ------------------------------------------- <br /> B <br /> BUILDING PERMIT ISSUED_______ ________._ ------------------------ DATE.......................................-------------------- <br /> g <br /> Alterations and/or recommendations: . _-._ --------- -------------------------------- <br /> & <br /> --- ------- AA.-e..... <br /> -------------­-------------------------------------------------------- -_--------------------- <br /> --------------------------------------------------------------------­----------- ----------------------- <br /> -------------------------------------------------------------------------------------------:----------*---------------------- ----------------------------------------------------------- <br /> ----------------------------------------------------------------4 ----------*--------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> • <br /> ............................ ............._------! <br /> ­ .. -------------------------------------------------------------- -------------------------------------------------------------------------------------------- <br /> FINAL INSPECTION / - <br /> ---BY:� -- -- -- --------- Date------.---- -- <br /> JOA UlW-LOCAL-HEALTH;DISTRICT, <br /> "', -A <br /> 130 South American Street 306'West Oak Street 124 Sycamore Street 205 West 91h street <br /> StOCkl0r1r.Callfornia LocR,California Manteca,California Tracy Californiatn <br /> X. <br /> EG 9 REVISED B-59 9M 5-61 ATLAS <br />