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Fbk�OFFICE USE: ry <br /> --------------------------- --------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. ........ <br /> (Complete in Duplicate) Issued <br /> -------------- ---------------------------------------- Date <br /> ---------------------- This Permit Expires 1 Year From Date Issued <br />---------- ---------------------- <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install th;Wrk h;rein described. <br /> This application is made in compliance with County Ordinance No. 549. �A.OkJ � <br /> t(�&sv <br /> ............ <br /> JOB ADDRESS OCATvo _,,& ------ ...... -------- <br /> L ...............I...... <br /> C', - <br /> 71— or <br /> Owner's Name--- .1.................................................... -------------­--------------------------- Phone................ .................. <br /> -----------------------------------•......................I............................................. <br /> Contractor's Name..------.... .I-- ------ ......... .,,.......k------ - ----- --------- ......................................... Phone................-------------------- <br /> A. Commercial E] Trailer Court El Motel 0 Other 0 <br /> Installation will serve: Residence Apartment House 171 <br /> 0 <br /> Num15'er of living units: Number of bedrooms Number of baths -.-_1.. Lot size ------------------------- .........................I--------- <br /> Water Supply: Public system 0 Corn I munify system El Private [Z Depth to Water Table -------- ft. <br /> Character-of-soil-to a depth of 3 feet: Sand E] Gravel E] Sandy Loam 1% Clay Loam [3 Clay [] Adobe C] Hardpan C] <br /> Previous Application Made: (If yes,date--- ----------------) No ❑ New Construction: Yes Ej No E] FHA/VA.. Yes El No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank-or c6sspoo[.permitted if public sewer is available within 200 feet.) <br /> ft laferial------ ....... <br /> Septic J;afik: Diiia ncefrom nearest well__-1� ------Distance from foundation------$.........IV ­------- <br /> men ff5_;�Vbquicl depffi---------4-j---------Capacity...4j7;9 <br /> No. of omp�ri� ts------- -7;?�=--------Size--..3/W <br /> *rest lot line___--..:.._-. <br /> Disposal Field: Distance from nearest well------------------Distance from foundation....................Distance to no i, <br /> El Number of lines-----------------------------------Length of each line--------------------------Width of trench...-------------------------------- <br /> Type of filter material-----•-----------------Depth of filter material---------_------------Total length--------------_------------------------- <br /> est lot line---.............. .. <br /> Seepage Pit: Distance to nearest well-----------------------Distance from foundation--_---------------Distance to near -----------------------_........ <br /> Number of pits------------------------Lining material..----------_---------Size: Diameter------------_---------Dept h <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-------------------Lining material..-._______-______-.____.--.-___..... '� LJ <br /> ❑ Size: <br /> aterial..--------------------------------- <br /> Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> nce from nearest building------------------------------------------ <br /> Privy: Distance from nearest well-----------------------------------------I - ------------Dista <br /> ...............---­------------------------------------------- I------------------- <br /> 0 -—Distance to nearest 16f-lin-'e ------------------------------- -------------------- <br /> i Remodeling and/or repairing (clescribe):--- -------- ----- . ...... <br /> .� --7, �, , - � _7 .1. 1 . I .............. ----------------- <br /> ---------------------------------------------------------------------------------- ------.................:... ..................... <br /> ---------------I-----------­--v-----------­ - <br /> de r 76 <br /> ---------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------w----------------I........................--------------- <br /> .......:-------I--------------------------- IV <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 law and rules and repul fivs of thioan Joaquin Local Health District. <br /> nor an or Contractor),. <br /> ----------- --------------------------------------(e* <br /> (Signed)---_---_---ktivlz-.�----- ------- (Title)--------------- --------------------­-- ---7---------------- <br /> By:-----------------------------------------------------------------------------------r----------------------------*---------------------- <br /> (Plot plan, showing six�.-of-116t,"lo'cation of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> r <br /> FOR DEPARTMENT USE ONLY <br /> ----_----------------- <br /> APPLICATIONACCEPTED 0"-- -- - ------- -- --------------------------------•-•-----------•-------------- DATE_ <br /> REVIEWEDBY-----------------------------------------------------------------------------------------------------------------------­.- DATE_-.----------------------------------_------------------ <br /> BUILDINGPERMIT ISSUED---------------------------------------------- ----------_-–------------------------------------- DATE---------------------------------------------------------!- <br /> Alterations and/or recommendations:---------------------- ....................................................... <br /> - ------------------------------------------------------------------------- - <br /> --------------------------------------•--•--•--••-•----••------------------...------•-- ....I-------------------I——---------------- <br /> ----------r------------------------------------------- ------------------------------------------------------------------­---------------------------- ------------------------------------------------------ ------ <br /> -------------...................... ........................ . ------------------------------------- --------------------------------- ----------------------------I---------.........................I--------------------- <br /> ---------------------------------------------------------------------------------- ----------------------------------------------------- <br /> -----------------_-------- ------- ------------------------------------ .......... <br /> ee_ Date--- -----------------­----------- <br /> -- -- --------------- <br /> FINAL INSPECTION _---------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Sireot 1114 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> \Er, 9 REVISED 8-59 21A 0-61 ATLAS <br />