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FOR OFFICE USE: <br /> APPLICATION ht <br /> , ' <br /> R FOR SANITATION PERMIT Permit No. ..�___. - <br /> ' ' ' Complete in Duplicate) 7j <br /> „• Date Issued ----•�..-f_.. <br /> This Permit Expires 1 Year From Date Issued_ <br /> Applica4ion`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 Coun 0 di No. 549. <br /> J08 <br /> 9/ ------ <br /> ADDRESS A OCATIO . .....-- . ........ <br /> Owner's Name - ---------------- -------------- Phone <br /> Address...--------- <br /> - - - --- - ---- <br /> Contractor's Na e - Phone <br /> --•--- <br /> Installation will serve: Residence 'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: .Z.. Number of bedrooms Number of baths /_.. Lot size _______________________ <br /> Water Supply; Public system Vk`t—&imunity system ❑ Private ❑ Depth to Water Table 4J. ft. <br /> E Character of soil to a:depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe g?'Tlardpan ❑ <br /> Previous Application Mede: (If yes,date----------- ------__-) No New Construction: Yes [:] No ®-'1HA/VA: Yes E] NoPg— <br /> TYPE 01= INSTALLxATION AND.SPECIFICATIONS: <br /> (No septic tank or.cesspool permitted if public sewer is available within 200 feet.) <br /> Se tic�Tank: a Distance from nearest well-----------------Distance from foundation_________-___--___Material................................................. <br /> No;,of compartments---------------------_ _Size-------------------------------Liquid depth-.------------------------Capacity....................... <br /> Disposa} Field: Distance from nearest well---e— Distance from foundation___ ...._.Distance to nearest lot line- ....... <br /> E <br /> Vt..-f <br /> Number of lines_____f__.___ ___ __-_ - Length of each line.-,/ ________y_______-Width of french_�.__�___-____Type of filter material - -fi _Depth of filter material___ �_______-.Total length..... _________________________Seepage Distance to nearest well-__-:77�-------Distance f m fo ndation-/ ..j"Stance to nearest lot� Number of pits...._____________Lining materiaLWee— --Size: Diamete _______Depth_ .�-­______-______ T\ <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 building______--_-_--_.____-__---______-._____-- <br /> ❑ Distance to nearest lot line------------------------------------ <br /> Remodeling and/or repairing (describe)--------------_--- ----- --.. .. ...11l!.... . .........•--------------•-........................................ <br /> -----------------------•-------••----------- •-----•-•-----------•-----------------------------------------------------------------------•---•--•--------•------------••--------•------------•-------------------- <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 rul and regulations of the San Joaquin Local Health'',District. <br /> (Signed)...-•------------ -- ---- -- ---- - ---------------- ----- -------------->�if or Contractor) <br /> By:---------------------------------------------------------------------- (Title) f - -�L--_...------- ---- --------- <br /> (Plot plan, showing size of lot, location of syste 1 elation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------- ------------------------------------------------------------------ DATE------- 4---`2�f-._a ----------------------- <br /> REVIEWED BY----------------------------------------------------------------------------------------------------------•------------------ DATE•----------------------------- - <br /> -- ----------------------- <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------........................------------------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations---•--------- ------------------•-------•---------------.---------------------------------------- <br /> 1 .-.� K (',�''--------•---------------------------------------------------•................. <br /> ..........-----------------------------:---------------------------------------------------------------------------------•----------_------------------------------------------------------------------------------------ <br /> FINAL. INSPECTION BY:-------- 7. 4-" Date------fid rr �A 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 /> ES 9 REVISED S-59 7M 5-61 ATLAS <br /> a <br />