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FOR OFFICP USE: 1--14 ,4 t03 <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------------------- ----------------- ------- ------- (Complete in Duplicate) fQ �- <br /> 1 f ``�- a Date Issued .------ •�-------- <br /> _�L This Permit Expires t 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 application is made in compliance with County Ordinance No. 549.jiog <br /> - <br /> JOB ADDRESS AND LOCATION / — = .�. ... '..- •• 'l <br /> Owner's Name----- 4.o r 107 Phone <br /> Address......_.. ---------------------------------------------------------- ----------._..._---•------------ <br /> Y <br /> Contractor's Name...... .. _�:...-- - �----�--------- - ---------------------------------------- -- <br /> ---- Phone_.............--•------------- <br /> Installation will serve: Residence El"A'partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _.�----- Number of bedrooms$_;,Number of baths _/___ Lot size ---�_�-`X_J_t�rp-�____------------------ <br /> Water Supply: Public system (Community system ❑ Private ❑ Depth To Water Table 1/1- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: llf yes,date--------------_----) No V�New Construction: Yes UK<o ❑ FHA/VA: Yes ❑ No E�-� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> } Septic Ta : Distance from nearest well----_--___.-._Distance from foundation___��.�......MatgriaLi._4Z_ Ce___________________ <br /> No. of compartments------Z--------------Size__,"X_�V......._Liquid depth----3.1 -----------.-Capacity.....---.-----• ___-- <br /> 1 Disposal Field: Distance from nearest well_._-------..Distance fr }�u�r Ition_JP..�__._____.Distance to nearest lot line.--'S__._-... <br /> J s' <br /> Number of lines------- _______.._.._ __�_Length o e c lmeali�✓_____.Width of trench__o _ ____________________ <br /> Type of filter material..._#_.-._-1�y___Depth of filter material...��-�'_---------Total length----1���________________I......... <br /> i -- <br /> Seepage Pit- Distance to nearest well----�-------------Distance from foundation----1 d---------Distance to nearest lot lines----_------ <br /> [j� Number of pits.___----_._-._Lining material.-G1C----__.Size: Diameter-_-3I'"4.-------Depth___a_,-----........----------- <br /> Cesspool: t Distance from nearest well------------------Distance from foundation--------------------Lining material-------------------------------.___-_ <br /> ❑ Size: Diameter--------------------------------------Depth-------------------------.--------------------------Liquid Capacity---.. -. -----------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------- from nearest building_--.---_-_-__-__________-_-__.-._.-__-_--- <br /> C❑ Distance to nearest lot line----------------------------------------------------------------------------------------------------------------------•--•------------------ <br /> Remodeling and/or repairing (describe)------------- �..r•J .------- .....-- i• ....---•--•----••--------•--------- <br /> . 11 <br /> ----------------------------------------------------------------•-•.-•---------------------------------------------------------------------------------------------------------------------------- <br /> ------•----------------------------------------•-----------•-•--------•----------•-------------------------------------- --------------------------------------------------------------------------------------------- <br /> 1 I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> I ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> r (Signed).................... ----•�ofisysfem <br /> ti -- -------------------------- - (Owner d/or Contractor) <br /> B �- <br /> y-------•---•-------------------. (Title}.. <br /> (Plot plan, showing size of l t, I cation in relation to wells, buildings.. , can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_-. ._- .-.- -------------------------- DATE---.--.—---6 � �-__ -------- <br /> REVIEWEDBY-------------------•---•----- - --- •--- --------------------•- --------------------------------------------- DATE---- -----------•--•------ <br /> BUILDINGPERMIT ISSUED.....------------- -------------------------------------------------------••------------------------ DATE-------------------------- ----------------------------------- <br /> ------------------ <br /> --------- ..------------- <br /> Alterations and/or recomm dations: <br /> Y r , - <br /> I �1 .�_:.:.f/'_____�_�:'Y .__ "- � � J `� -� _VS:_._ <br /> ---------------------------•---.-.L.L�LTIlf_2_..L!4�__.jft.4�Y'cr �- = �4'�rrf•�``----__`1_^.- _..{........... - <br /> -----------------------------_--.--------------------.--.------_-.--_-..-----------------.------------- ---•---------------------------------------------- ------------------------------------------------------------ <br /> I - ------ .. <br /> FINAL <br /> ------------._------•-_--•----------------------------•--- <br /> FINAL INSPECTIONi BY:---` Date v ./ .�. .� ---- <br /> / SAN JOAQUIN-LOCAL HEALTH DISTRICT <br /> 130 South American Street a 300 West Oak Street 124 Sycamore Street 205 Wast 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED B-59 2M 5-62 ATLAS <br />