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-7 FOR(..FFICE USE:,, <br /> - ----------- <br /> APPLICATION FOR,.SANITATION PERMIT Permit No. <br /> ------------------ ------------------- ------------------ It <br /> (Complete in Duplicate) % -�, <br /> K:0 <br /> -------------------------- This Permit Expires I 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 complianc-e with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION..._!- - ---- --- <br /> . .............. <br /> Owner's Name-------•a------- -------- X--------- ---------------------------------------------------- <br /> -Phone ..... <br /> Address--•-•... •.•-•,--- <br /> Contractor's Name.... ... - - ----- <br /> 2 <br /> Installation will serve: Residence Ey'—Apa ment House El Commercial E] Trailer Court [] Motel 0 Other 0 <br /> Number of living units: -/.-. Number of bedrooms Number of baths ..I... Lot size .................... <br /> Wafer Supply. Public system d—eom1munity system 0 Private E] Depth to Water Table�Gft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel [] Sand Loam E] �,Clay Loam [:1 Clay [] Adobe f2­14—ard—pan C] <br /> i I I � y Q <br /> Previous-,Application Made: {If Y'es,date--------------------} No �—­New Construction: Yes E] 'FHA/VA- Yes [I No <br /> - I <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) `161% <br /> Septic Tank: Distance from nearest well----_-------_-_-Distance from foundation----------------_--Material----------------=................................ <br /> No. of compartmentis--------------------------Size--------------------------------Liquid clepth---------------- ---------capacity....................... <br /> I L <br /> Dispose ield: Distance from nearest well--____---.------Distance from foundation....................Distance to nearest lot line__..__-.._....... <br /> Number of lines--'------------------------- <br /> .-------Length,of each-line-----------_ of french----------------------------------- <br /> Type of filter material-------------------------Depth of filter material-----------------------Total length-__:_--_---------........-__-___.--._-_-.. <br /> I. I <br /> Seep ge Pit: Distance to nearest well- Distance from f clation.-A _j.____.Distance to nearest lot <br /> -7 , - 5- <br /> Number of pits---!...)-------------Lining material - k------Size: Diameter__��F............Depth___-_-4�........................ <br /> Cesspool: Distance from nearest well.................Distance from foundation--------_--_-------.Lining material-----___.:_ --___--_------__--___-_ . <br /> ❑, <br /> aterial-------­--------------------------- <br /> 0, Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity`---------7 ------_gals. <br /> Priv Distance from nearest well-------------------------------------------------Distance from nearest building---- ----------- <br /> A -,, ------------------------ <br /> ❑ <br /> Distance to nearest,lot line-- ------ ------------------------------------------------ ------- I <br /> -- -----------I----­-------------------- <br /> Remodel ing,and/or repairing -rite _-( ---- --- -- --- ------ --------- <br /> tic, <br /> ------------------ ------------------------------- ----------------------- ------------------ -------------\-------------- <br /> ------------ ---------- ---­--------- <br /> .. .......... ------ J�......... . <br /> e wor I an Joaquin-County <br /> y at pr are#e , p i n <br /> I hereby zvi�um e ne i�rdaWc' ffi S <br /> ordinances, tate laws, apd rules d gy, tions 99 the J a in Local Healf District. <br /> (Signedl.. <br /> --- -- --- ---- - -j--- - -----------------------------------------(Owner nd/or Confracfo.r) <br /> - - <br /> ---------------------------------------------------------------------------- ............. <br /> '.�-Vh win s location of system in relation to wells, building$, etc., can be laced <br /> (Plot plan,� lot loc ced on <br /> FOR DLPARTMENT USE ONLY <br /> ----- <br /> APPLICATION ACCEPTED BYL <br /> ­ -- ---- ------------------------------------- I DATE. <br /> --- __ <br /> REVIEWED BY-n' s,�._2t- <br /> ......................... --------I---------------- ------------ -----------------------------••- DATt- ----- <br /> - -------------------- -------------- <br /> BUILDING PERMIVISSUED--------- - ---- .. .......... .........-------------- <br /> --------------------- -----------.... DATE-------- -------------- ------------------------------- <br /> Alteratio s and or recomme dations:-_---------__-- „----- ---- --- Z <br /> ------------- <br /> - ---- ---- -- <br /> 44- <br /> ---------------- ................... <br /> ................. <br /> ............ ................ _------- <br /> .......... --------------- --------- <br /> -- ---- ------------ ----------- - ------------------------------- J <br /> Af, <br /> FINAL INSPECTION BY---------- _ ---- ---- -------------- Date-----:41-------- ------------------ ---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California j. <br /> ES 9 REVISED 0-3$0 ZM 0-61 ATLAB <br />