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!OR OFFICE USE: <br /> ----------------- -- --------------------------- <br /> --- APPLICATION FOR SANITATION PERMIT Permit No. _,�i X1 <br /> -- ------------- <br /> ---- ---------I------------------ -- -- <br /> --------- <br /> --------- ---------------------------- ---------- (Comple+e.:in Duplicate) A7 <br /> --------- <br /> --------------- -- ----------------------------- This Permit Expires I Year From Date Issued <br /> Date Issued -- <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install t4 e work herein described. <br /> This application is made in compliance with County Ordinance IN 549 <br /> j2w 3 <br /> JOB ADDRESS AND LOCATION ---------- -------------------------------- ----- <br /> Owner's Name._�X­ e. --- - - - ------------------- ------------... Phone.----------------------------------- <br /> ------------------------------------ ----- <br /> Address------5_33Z 9 ----------- ------------------------------------------------------------------------------------------------------------------- <br /> Z47 --------------------- ------- ------ --------------------------------------- Phone------ --------------------------- <br /> Contractor's Name.------------------------------ ------------- <br /> Installation will serve: Residence RD"Apartment House'[] Commercial'IL] Trailer Court 0 Motel [-I Other ❑ <br /> Number of living units: _- L- Number of bedrooms dumber of-baths ----- Lot size J-7, -4,t__ ------------------- <br /> Wafer Supply: Public system 0 Community system E] Private El' D;pth to Water Table-30- ft <br /> Character of soil to a depth of 3 feet- Sand 2--"Gravel E] Sandy Loam El Clay Loam Clay E] Adobe 0 Hardpan ❑ <br /> Previous Application Made: (if yes,date----------- --- --- ) No New Construction: Yes �N6 E] FHA/VA: Yes Ej No pi__� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> 74- <br /> Septic Tank: Distance from nearest well__t5�0---V----Disf8nce from fou'ridat'on ----------._..Material --------------------- ------------- - <br /> 9r, No. of comparfments_____2,.------------ - Size---- -----Liquid depth------'I<------- ------ Capacity__-�i <br /> Disposal Field: Distance from nearest wefl__,5_0_ra-...Distance from foundation-110 D* lot line' &. <br /> -------.Distance to nearest ----------------- <br /> Number of iines------ ---------------- ---------Length of each line_ -`---- ------------Width of trench..-29_q-------..------------- <br /> Type of filter material---, t2cx_ _Depth of filter maferia ------------Total length--_- 44--*- <br /> ----- -------- -------- <br /> Seepage Pit: Distance to nearest well......................Distance from foundation-------------------Disfarice to nearest Gf line.----_---.----. <br /> ❑ <br /> ine-----_--------- <br /> 171 Number of pits--- ------------------Lining material---------------------- Size: Diameter----_-----------------Depth-.-------- ---------------------- <br /> Cesspool; Distance from nearest well ----------------Distance from foundation ..Lining material-.._.-..____----------------------- <br /> F-71 Size: Diameter- -_ _------ -- -- ------ --------.Depth._------------ -------- -- . .......... ---------Liquid Capacity_-------------------------gals. <br /> Privy: Distance from nearest well-.-.___..............._-----.--_-- -----_ - Distance from nearest building___.__---_.__-------------------------- _ <br /> ElDistance to nearest lot line _............. --------------- -------------------------------------------------------------------------------------------------------------- <br /> fl p� 1-2 1 � — 5(/13 0 <br /> ...... <br /> Remodeling and/or repairing (describe}:.....' ------ - ------------------------ - ---------------------------------------------------------------------------- <br /> •-------------------------------------------- --------------------- ----------------------- ---------------------------------------------------------------­­------------------------------------------------- <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 YIWY and rules and regulations of the San Joaquin Local Health District. <br /> _ <br /> (Signedj ----- 4,itea J.--7'S.:-------------------------- - ( Wor Contractor) <br /> BY: ----------------------------------- ------------------------------(Title)----- --- ------------- ....... .......____............. <br /> (Plot-plan7-showing size-of-lo Hocation-of-system-in--relation-to-wells,-buildings.-etc.,—ean-be-pla-ce-d-on-roversesidei)-- <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY. DATE--- ------ --------0------ - <br /> - <br /> REVIEWED --- - -- - ---- -- --- ------------ ------ - --- - <br /> REVIEWED BY--------.... -------- -------- .......... ... ---------------------- ---- ---------------------------------------------- DATE-------- --------------------- ------------------------ <br /> BUILDINGPERMIT ISSUED.---------------------------------------------------------------------------------------------------- DATE---- ---------------------------- -----------_-------------- <br /> Alterationsand/or recommendations:----------------- -------------------------- - ----------------------------------------------------------- ---------- ---------- ----------------------------- <br /> ------------------------ --- ---------­----------I.......... ......I............ -------- - --------------------------------------------- -------------------------------------- -------------- ----1-11------------- <br /> ------------- -------------------------- ----- --- ------- ------ --- --------- -------- .... --------------- ----------------------------------------------------- ----------------------------------------- <br /> ------------- -- ------------------- ----------------- --- --- --­_­-- - --- -- -- -- ---------------------------I------­------------------------------- --------------------- ----------- <br /> ------------------------------------ -------------- ....... ----- --- ------ - - ----------------------- -------------------------------------------------- ------- --- --------- - ----- <br /> FINAL INSPECTIC Date------------ .....................!......... <br /> --------- -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 F.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> E,H.9 2M 1-67 VangUaTc!Press <br />