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KUNILp u..t: <br /> ---------- f �� � <br /> APPLICATION FOR SANITATION PERMIT Permit No. ... <br /> ...._. . ..... <br />--------------------------------------------------------- (Complete in Duplicate) ♦ 7 4� <br /> Date Issued .....,..��° .� <br />------------------------------ -------------------------- This Permit Expires 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 applications is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION.---_'`�i�� <br /> Owner's Name------ <br /> ---------- .r� - ----- Phone... I <br /> Addressr "[K,y •• ! --•-•-----------•---------------------------••---•----.........----------------------------------------------.......................... <br /> Contractor's Name.—,. --�-- -.�..-------------------------------------- -----------------------------------------------•--------------- Phone................................ hI <br /> Installation will serve: Res idence'V3,"Apa rtment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 0 f <br /> Number of living units: _f.... Number of bedrooms -_ Number of baths I--_- Lot size ?..................... <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. t <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe45-_­Hardpan ❑ <br /> Previous Application Made: (If yes,dpte--------------------) iNo ❑ •New Construction: Yes �No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: t <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - <br /> Septic Tnk: Distance from nearest well ---.Distance from foundation!-.r/.T. _......Mate�riiJ <br /> No. of compartments---------�----.-----Size---_��-�! .. .Liquid depth--.......`T --------- <br /> Capacnty._ ' <br /> 7 <br /> Dispose ield: Distance from nearest well-. �- Distance_ from foundation..._._0_.-----Distance to nearest lot lin ,..�..... <br /> (� Number of lines----------- <br /> --Length of each line--- -�.__�- Width of trench....y.._-_-- <br /> -- <br /> --- ---Total length r'------------------------- <br /> Type of filter material'.�� ---Length <br /> of filter material----- g � <br /> Seepage Pit: Distance to nearest well-- G'?`�__.Distance from foundation---1'G!........Dista nce to nearest lot lineJ. . <br /> Number of pits--------ki--.------Lining material-,<) --.-Size: Diameter-..1-7----------.-.Depth----��................. <br /> Cesspool: Distance from nearest well----.,,..........Distance from foundation--------------------Lining material..--_---.-..---.---.--..------------_ <br /> ❑ Size: Diameter e---••---------------------------------Depth-------------------------------------- ----------...Liquid Capacity---------------------------- 1 <br /> Privy: Distance from nearestlwell-------------------------------------------------Distance from nearest building �! <br /> ❑ Distance to nearest lot line----------------------------------------------------------................------------------------------------------------------..----------- <br /> Remodelingand/or repairing (describe)-- ------------------------------------------ -----------------------------•-------•---...-...------•------•-.......-----------------•--------•--.------ <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 rusand regulations of the San Joaquin Local Health District. <br /> (Signed] 4_11 -- <br /> (. (Owner and/or Contractor) <br /> BY: =r`` ' � ..r !'{.` - �.-�' ' `. .(Title�•----- ��~ � t =.... .... <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> E <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------- ------ -------------- __---- . <br /> REVIEWEDBY-------------------------- ................... --------------------------------------------- DATE---------------------------- <br /> BUILDING PERMIT ISSUED.....................---•------------------------------- ---------;---------------------------------- DATE----------------------------------------... <br /> Alterations and orrecommend tions:--- _ -,- r _....... —r- f r �- <br /> - ec c-u------ ✓-----�-/---------=--------- <br /> = -- ------------------------------------------ <br /> -------------- <br /> ::: = <br /> --------. - ----- <br /> -------------••-- ....... <br /> ------- *_-6�7/...... -------e2. 1=� r �-f--- <br /> FINAL INSPECTION BY:.--------N.--- _-t� '. f_ Date----------------- <br /> --------- <br /> --------------- l <br /> SAN J AQUIN LOCAL HEALTH DISTRICT �Q -� e <br /> 130 South American Street 300 West Oak Srreet 124 Sycamore Street 205 Wesf 9th Street <br /> Stockton,California Lodi,California Mantua,California Tracy,California <br /> a ' <br /> ES 9 REWBEC 6-89 EM 6-61 A7LAS <br />