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( 5 <br /> -----------_----------- --------- <br /> __1Gp. <br /> --------- APPLICATION FOR SANlTATIQN PERMIT Permit No—_-- 9---------------------------------- ------- --------- (Complete in Duplicate) f <br /> -------- - Date Issued v <br /> This Permit Expires 1 Year From Date Issued <br /> Application is hereby irnade 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 Ordain ce N 49. - <br /> JOB ADDRESS-AND <br /> pp� <br /> CATION -------------•---•---------------------------- <br /> Owner's Name-- ----- 2--'. ....... <br /> Address--------------- --- ------------=---- ---- ------ -----'1 1 '- { -------------------------------------------------- <br /> Contractor's <br /> --------------------------------- --------•---{ ------------- <br /> Installation <br /> --------- orte 4t_ � a- <br /> Name---- Ph <br /> Installation will serve: Residence A artment House Commercial ; <br /> �' p ❑ ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: Number of bedrooms -,*2..Number of baths -/.-.Lot size -S__�--- --/ Jr 49 <br /> ------------- <br /> Water Supply: Public, system Community system ❑ Private ❑ Depth to Water Table 4p. ft. <br /> Character of soil to a He <br /> epth of 3 feet: I Sand ❑ Gravel ❑ Sandy Loam.E] Clay Loam E] Clay E] Adobe Hardpan ❑ <br /> Previous Application Made: (If yes,dotef?-S-�1----) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: y <br /> (No septic tank! or cesspool permitted if public sewer is available.within 200 feet.) <br /> t <br /> e ank: Di ktance from nearest well------------- Distance from-foundation_.------------------Materia#--.-__---.-------------------------------------- <br /> No. <br /> -----_-:.-..----_----------__-____-. <br /> N. of compartments--------:- Size - ___Liquid.depth-------------------------Capacity------------=------- <br /> ' Id: Distance from nearest well ,_.Distance from foundation__, Q__._____.Distance to nearest lot line-- .-...____ <br /> Number of lines_._.--- Length of each line____ d' ` <br /> [ 9 :-3..5 Width"of trench a ',----- --------- R� <br /> s Tye of filter material_5Ye __Depth of filter material-'- � -' Total lens9`th .,r r <br /> ---___ . <br /> Seepage Pit: s Distance to nearestwell----------------------Distance from foundation_--_.---------------Distance toInearest lot line--____---.------El O <br /> Number of pits_____ ________-------Lining material--------------------___Size. Diameter----- -- __Depth---------------------------------- <br /> Cesspool. Distance from nearest well----------------- Distance from foundation Lining <br /> ,.material------- ------------- <br /> �k -------- <br /> ❑ Sizle: Diameter------ --------------•--------=-------Depth-----------------------------------------------------Li uid Ce aci <br /> 9 p tY----------------------------gals. ; <br /> f � <br /> Privy: Distance from nearest well------------------------ ----------------------Distance from.nearest building^--:-------------------------:..I'_-_.__-----,- <br /> 1 <br /> - <br /> ❑ Distance to nearest'lot`line°--""---------------------- ---------------- __-__------__ <br /> 4r-i+.nw.�, ...a . .: ------- --------------------- -------- - - <br /> r' i <br /> L C <br /> Remodeling and/or: repairing (describe):--------------•----------------------- e ------------------------------------ <br /> ---------------- D <br /> ----------k---- ----1-------------------------- . . <br /> - -- ---- ---- <br /> --- ----- - <br /> - -------- <br /> -------------------------------°---- r <br /> = - ------------------ <br /> ---------- ----=•---------- <br /> I here s•rtify that I have prepared this application and that the work will be done in accordance with Sam Joaquin County <br /> ordinance Sta a [aws,..and rules and regulations,of the San Joaquin Local Health District.' a <br /> Si ned �-- - o <br /> a <br /> ( 9 )- ---- ----- er and/or Contract <br /> -, <br /> BY ----------• 0-- --------- [Title)- n o a <br /> [Plot plan, showing siie;•of lot, locattonKof system in;relation to wells; build' s,-etc., can be placed on reverse side). <br /> FOR DEPARTMENT,USE ONLYA,-o. <br /> APPLICATION ACCERTED BY �-�' ------------------------=---- '--------- DATE_ �� -�f �_ --------- -------------- <br /> REVIEWED BY--------------- <br /> ----- ------- -------------------•---------------------------------------- DATE---- <br /> BUILDING PERMIT ISS�'UED ­ <br /> --------------------------------------------------------------------------------------------K.,,,.�._----'------"-•DA•TE__7"----_--- " <br /> - ---- -- <br /> Alterations and/or recommendations: __-.---.--._---------- ------- <br /> ------ -------------------- <br /> ----------------- <br /> •.- <br /> y J G'� <br /> * t�aC <br /> -.� <br /> ---------- ----- __ --------------------- <br /> ko <br /> ---------- -- -- --- --------- -------------------------- -- - <br /> --- ------------------------------------------ 3 <br /> '® <br /> �� � / <br /> FINAL."INSPECTION :BY:----- �". 7�Ld� _� .........=------ C' Date---------- <br /> -:� ------------ - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haselton.Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street o- <br /> Stockton,California Lodi,California Manteca,California Tracy,California a <br /> CS 9 REVISED 9.59 3M 3063 PIP.013. <br /> i <br />