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FOR OFFICE USE; <br /> ---------------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br />--------- ---------------------------------------------- (Complete in Duplicate) /Issued -------.•---3 -. �3 <br /> ------- ----------------------------------- This Permit Expires I Year From Date Issued <br /> Application is{hereby rade,to--the San Joaquin Local-.Health District for.6 permit to construct and install the work herein described. <br /> ? <br /> This application is made_.-jhcompliance with County Ordinance'No. 549.-1 <br /> 7 Z <br /> r3b a, <br /> "JOB AODRESS,AND LOCATIONA_'_/f­.-5--t...... - ----------------------------------- --••----•-=-=•----------------------- -- <br /> - -----­-- <br /> 747��f <br /> ----------------------------------------------- Phone............_----------- <br /> Owner's�'1'4ame.__­!_' <br /> ...1.1V----- .................. <br /> Address:_.......7 ----C/4 ............................................ <br /> Contrac4r's­N6Ae___,_I_tf ++ '❑ <br /> ----- ---- - 1 ---------- -- ------ ..... ................ <br /> hone;P- + , [2... <br /> 7..-.T <br /> Installation villieive_ Residence `Aoartme�f House '3CornrAerial ETrailer Court EMotel [] Other .. <br /> ........... <br /> 4. <br /> units: T1 e) <br /> ['Nurnber"of,living 'Its: ---------Number of bedrooms ---:'_'_'Numbdr­of` baths _?7�-Lot.size .............._-,...................................... <br /> Water'Slppl.y: %bli54S-Y"s--te-m ECommunity system `Privat�jEDepth to Wa <br /> t;r-Table ....._ ft. <br /> Character,of.soil to a depth of 3 foot: Sand Gravel E] 1Sand'16arn Clay Loom @'Clay C] Adobe E] Hardpan ❑ <br /> Previous Application Made. (if yes,date______________------ No e 2­7!�o E]. FHA/VA;.Yes E] No E�-� <br /> ,.LIN�w Construction: Yes <br /> TYPE PF,INSTALLATION t AND-SPECIFICATIONS: <br /> (No septic tan <br /> k, I permitted if public' sewer`is available within 200 feet.) <br /> -.o r cesspool <br /> Septic Tink: 1', Distance from`lnearest well-..,f-.O----------!Distanco from'foun"clation___6�.------- <br /> ��;................... <br /> 0. Liquid de.p.th.......... ------------ apauty <br /> - <br /> -cdmp trn n S_ ----- ------- <br /> Size__ <br /> ------ <br /> of af e t e... <br /> t_� t t I i <br /> Disposal' Fieid-:�,�­ Distance C) <br /> tance-from :nearest ------Dist'ance'fr-om' foundatio .........Distance to nearest lot ........... <br /> , ' of -2- Width of trench____________- - -2 ,............... <br /> �n�­'Nu;nber' of-'li'hes-- -ea <br /> ----- -----:---Length of t _q� <br /> Total length......... <br /> ---------- ------------------- <br /> J­`�­- Type o£-filter 'T' aterial... D;pth of Tilter', ma,teriaI___.__ <br /> :-Well ....... line_________________ <br /> Seepage� Distance to nearest- ---------- -----Distance from foundation______.':__.....___.Distance---Distanice to nearest lot line..... <br /> El _'Number6f:piti..... :---- Lining -------I------Size::Diamefe�r------- D6pth--------------------------------- <br /> Cesspool:. -�---Dis_fancejrorvi nearest well--------------:.....Distance from foundation_-----r..............Lining material?------------------------ <br /> S -------- -----------r......... <br /> JZe:11 iam6ter-------------------------------- ------ ...... ------:-------Liquid Capacity-------------------------------gals. <br /> T <br /> Privy- I D'istdnc6 Grhnearest well---------1_t. _t_. _ _:--_;_ Distance from nearest;build in <br /> .9-------------------"It",.........--------- <br /> 4 <br /> ----------- ------------------------------------------------...................................... ........... ........... <br /> ,Distan1ce +c; nearest�Iof line--.--' <br /> and/or' repairing. <br /> 'e; �i'i 'gl (describe):-_-___-______-' --------------------------------..............................................-------------- ----------- .................. <br /> Remodeling or_ a r n <br /> 1 r , � - I .. q I �­r a <br /> ---------------------------- ------- --------------------------------------------------------------------------- <br /> ------------------------------------------------------------- ---- ------------------- <br /> ................................... ------- ................................... ---------------- -------------------------------------I--­------­------------------------------------------------- <br /> ------------------------------------------------------ -----------------I------:----------------­------r-........................................7---------------------------------------------------------------------- <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 lal�s, and rules and regulations of the San Joaquin Local Health District. <br /> ------------------------------------------------------------------------------(Owner and/or Contractor) <br /> (Signed) \------------ <br /> .........................-----------------............... ------------------------------------------------------- .............(Title).................................................... ---------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> r 1 -7 <br /> APPLICATION ACCEPTED IiY__:A'� ---------- ------­---------�.7------- <br /> Iret-�_ ------------7 --------------------------------- <br /> REVIEWED BY_----_------------- -------- ------ - - <br /> ---------------- --------------------------------- DATE---•--: ---_------ ---_-----------------------=- <br /> ' <br /> D4TE <br /> ----------7----- --------- <br /> DATE----------- <br /> BUILDING PERMIT.ISSUED------- ......."YLTI-1---------- <br /> ct f. . TO-0 <br /> -------- - -- ------- ------- <br /> c mrn <br /> AlferaTons a dlqr re ------------------------------------� <br /> -----­--------------- <br /> ------------------------------..................------- <br /> ... ........ ---------- <br /> y ............ <br /> - - --------- <br /> ..........�;�_ ..... --- ----------- ---------------------------------­­ -------------------------------------------....... ----------- ........--0. <br /> ---- ------------------------------------------------­ __0 <br /> ....... ------ <br /> ------------ ------------­----------- 7----------------------------------------------------- --------------------------------------------------------------------------------------------------------------- <br /> 17- - <br /> -CTION Y, ------------ ---—------------------------------------- ------------------------- <br /> FINAL <br /> INSPECTION 8 -- -------- <br /> ----- --------- -------- <br /> ' SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Sireet 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodir California Manteca,California Tracy,California <br /> ES 9 REVISED G-a9 2M S-61 ATLAS <br />