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FOR OFFICE USE- <br /> ----------------------------------------------------- --- <br /> ------------------------------------ ------------­ APPLICATION FOR SANITATION PERMIT Permit No. ..... <br /> -- --------------------- ------------------------------ (Complete in Duplicate) <br /> l�l .1 - -­ ! ..: Date Issued <br /> ------------------------:__7---�'------------------- ---------- This PermLUx ires 1 Year From Date Issued <br /> A�p i <br /> , plicatiori-is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This 'tiorijis-'rtacle in.66mpliagce with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION ..A------------- ---------- 4 ------------ ........................ <br /> ------------------ <br /> Owner's Name._.,>�-�_ __ --------------------------------------- ---------------------------------------­-- Phone------------------------------------ <br /> Address-- ................1.4 ........................................................ <br /> Contractor's N a --------------------------------------------------------------------------------------------------------------------- Phone..------.....__.....---.....-- <br /> 1 40 �% <br /> Installation "Will serve. Residence Apartment House [] Commercial E] Trailer Court ❑ Motel 0 Other 0 <br /> Number of living units: J----- Number of bedrooms Number of baths ___1___ Lot size . .. .. ............... <br /> .. .....*......... <br /> - ---------- -- - ------------ <br /> Water Supply. Public system C3 ommunity system El Private Depth to Water Table7,0. ft. <br /> 01 <br /> depth of 3 f Sand 0 Gravel 0 Sandy Loam ❑ Clay Loam 0] Clay E] <br /> eet. <br /> Character.of soil toe Adobe 0 Hardpan IM <br /> Previous Application Made: {If yesidate-------------------- []No ❑ New Construction: Yes ❑ No.E] FHAi_VA)Yes ❑ No ❑ <br /> TYPE OF-INSTALLATION-AND.SPECIFICATIONS: 416. <br /> -4d public within(i4o septi.�7fank'or cesspool permitted if e i pu ic sewer is available 200,feef <br /> Septic Tank: Distance from 'nearest well-4-P--------Dist frg-lm foundation-.-- &W <br /> e ----------------Mateppi------------------------------:x............... <br /> id dep�k-----------Y--------I---C�p;,--,�.l.....•-•.......- <br /> No. of compart encs_---;��----------------sill---)Pe�:t Liqu <br /> yv - III - i C, <br /> Disposal Field: Distance from neiare.9 we]14-.P----------Distance from foundation_Z-4------------Distance Onearest lot llnel�_.......... <br /> Number of line,31.....of—---------------0------- Length of each line_____--/1:K'17. ----------__-___._-._.Width of tr%nch._A7n'V__'y---------------- <br /> Type of filter Aate,i 4_1W.Depth of filter maferial.._Af�.___.._...Total lengtk_..A-171)�........................... <br /> 1111 4*4 1 ; I <br /> Seepage Pit: Distance to nearest well.../ __-___-__Distance from. founclation.Z6............Distance to nearest Iot.line_.%f'7.......... <br /> Number of pitsiLA--------------Lining material� ---------.-Size: Dia'meter......32 ---..Depth.,X�47 ................. <br /> 0 '40 <br /> Cesspool: Distance from nearest well-.-.-------------Distance from foundation--- ---------------Lining material...________________________________-: <br /> U Size: Diameterl--------------------- -------------Depth---------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from "��-earest,well-------------------------------------------------Distance from nearest building------------------------------------------ <br /> ❑ Distance to neal�est lot line------------------------------------------------ -------------------------------------------------------------------------------------------- <br /> Remodeling and/or 'repairing (desfibe):---------------------------------------------------------------------------------------------------------------------------*-------- ........... <br /> .......................I---------------------------10---------------------------------------------------------------------------------------------------------------------------------------------------- - <br /> ----- <br /> ----------------------------------------------------------1L.,_.......................................................--------•-•------••---•--------- ---------• ------------------------------------------------------- <br /> --------------- <br /> -------­---------­- ------------------w__P----------------------------------------------------------------------------------------------------------------------------------­....................... <br /> I hereby certify that I have pr4itpared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws-, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed ........ ----------------- --- ---- ---------------------r--------------------------------------------------------------------------------------(Owner and/or Contractor) <br /> --------------- <br /> t-Pkfy <br /> -------------- <br /> (Plot plan, showing size of lot, lo `on system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED B LE- 2------------- <br /> REVIEWED13Y._......_... ,_--------------------------------------------------------------------------------------------- DATE.............................................. <br /> BUILDING PERMIT ISSUED---------_0 --------------- DATE----------------------------------------------------------- <br /> -----------------•.....------------------------ <br /> Alterationsand/or recommendations:-------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------­­......-1---------------------------------------------------------------------------------------------- <br /> ----------L--------- -------------- ------------------I--------------------- ------------------------------------------------------------------------------------------------I---------------------------------- ------------ <br /> ........... ---------------------------------------6 <br /> t--------------------------------------------------------------------------------------------------------------------------------------*-------------------------- <br /> ------------------------------------ ------------------------- <br /> -------------- -- ----------­------------ -------------­.­------ ----------­----------- ....................---------------------------- <br /> FINAL INSPECTION BY:. Date..... ------------------------------- ------- -------- <br /> ------------------------- <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 5-59 2M 5-61 ATLAS <br />