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FOR OFFICE USE; <br /> A�_/-------7. <br /> ( .PPLICATION FOR SANITATION P�IT Permit <br /> ----------------- - ------------------------------------ (Complete in Duplicate) Date Issued ---- <br /> ----------------------------�­------------------------- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance ,tCounty Or4dina ce No. 549. <br /> ---------------- -------------------------- <br /> JOB ADDRESS AND LOCATION...___z <br /> ------------ ------- <br /> ------------------------------------------ Phone__&.1r ---'W-2.&V <br /> Owner's Name___n-��7 .. ...........54—�: <br /> 5iF <br /> Address----------------------------------------- I—----------------------------------------------------------------------------------------------------------- --------------- <br /> Conf ractor's N ZJAP---! <br /> ------------------ ---- Phone-- <br /> ame Name__ _ _ _ _______------ <br /> Installation will serve: Residence RK Apartment House [I Commercial [3 Trailer Court E] Motel E] Other W4414J67— <br /> Number of living units:*Number of bedrooms ._)�_Number of baths Lot size ---- ----------------------- <br /> -Water Supply: Public system El Community system"E] Priivate.�Z Depth to Water Table �Zpf t- <br /> Character of soil to a depth of_3 feet:,.Sand [] Gravel E] Sandy Loam D .Clay Loam El Clay E] Adobe CR(_ Hardpan C] 1 <br /> Previous Application Made: (if yes,date--------------------1 No El .New Construction: Yes [:] NoJFL PHA/VA: Yes E] No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> .(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> —Se05c1?r Distance from nearest-well______-_______Distance from.foundation--------------------Material------- ----------------------------------------- <br /> No. of compartments-----------------I........Size-----------------------------------Liquicl­deph-----------------------'--Capacity--•---------------- <br /> bis os Distance from nearest. weII_/VV_-.._.Distance from foundation____Ar=.--_-Distance to nearest lot line_,_,�--- <br /> Number of lines--------- ------ - LengW of each ----- - -Width of trench-----5=7.<Z-------------- <br /> ve <br /> 6 Q - - -------- <br /> Type of filter 4_ _______Depth of filter material__1_8_��--------Total length--------�? <br /> ------- --- <br /> 4- <br /> Distance to nearest ------Distanc�e <br /> - <br /> peg <br /> k= foundation----Zo-------Distance to nearest lot line------ <br /> #----Depth__.__of its_____I---------------Lining ___..Size: Diameter-Z- Z--- . ---------------- <br /> Cesspool: Distance from nearest well-----------------Distance rn ounclafion------------------- Lining material________________________.___-_--_-_. <br /> ❑ Size: <br /> aterial-------------------------------------- <br /> Size: Diameter-------- ------------------ ---------Depth----------------------------- ----------------------Liquid Capacity--------------------------..gals. <br /> Privy: Distance from nearest well-- _._____-____________._______._Distance from nearest building_------------------------------------- --- <br /> ---------------- <br /> ❑ Distance to nearest�.lot line-------------------------------------------- -----Mz----------------­---------------------------------------------- ---------------------- <br /> Remodeling and/or repairing (describe):-------- ------ ------ ------- ----- <br /> - <br /> --------------- <br /> --------------- ------ ---- -- --------- <br /> ----------------------------------------------------------------- ------- --------- <br /> ----------:--------------------------------------------------------------------------------Z-r---------------- --------- ---------------------------------- ------------------------------------------------------ <br /> ---------------------------------------------------------------------------•----------------------------------------------------------------------------•----------------------------------------------------- <br /> - <br /> I'hereby certify that'l have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, ,qte I s, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed ------- _'E'v CrContractor) k <br /> ----------- .. ......--"----(Title)-------------------------------------------------.................................. <br /> By:--------------------------------------------------------------------------------------------- -- -------------- <br /> (Plot plan, showing size of lot, location of system in relation to <br /> R6, buildings, tc., can be placed on reverse side), <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-.--- --------------------------------------------- DATE------? 4- ----------------- I <br /> REVIEWEDBY----- ------------------------------------- ------------------------------------------------- ---------------------------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED------------------------------ ---- ------------------------------------------------------------------ DATE------------------------------__------------------------- <br /> Alterations and/or recommep4alTin --------------------------- ------------------------------�j------- <br /> --------- ------ ---------- <br /> ---------- ... <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ------- -----------------­------- <br /> --------------------------------------------------------- ---------------------------------------------------------------------;---------------------------------------7---.----------------------------------------------- <br /> FINAL INSPECTION BY:...-- ..... -- ------------------------ Date-------------3?------- ,=----&--/------------------------------ <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 <br /> E9-9 REVISEO B-59 r.Px[3,2m <br />