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FOR OFFICE USE: <br /> --------- ------------------------j il;--- <br /> ------------ - ------------------------------------------- APPLICATION FO <br /> R SANITATION PERMIT Permit No. <br /> I (Complete in Duplicate) 6A <br /> ---------------------------------------------------- ---- <br /> --- ------------------------------- ---------------- This-Permit Expires I Year From Date Issued Date Issued -t_.............:----- �. <br /> Application <br /> ..........------ <br /> Application is hereby madelto the Son Joaquin Local Health District for a permit to construct and install the work herein described. <br /> g <br /> This application is made in compliance with County Ordinance No. 549. <br /> II <br /> 43 x1 e <br /> JOB ADDRESS AND L.00 I N-------- � <br /> AT 0 <br /> ------------------------------------------------------ -------------- <br /> ------------------------------------------------------ ------------ <br /> -7 '-' on" <br /> Owner's Name--------- -------- . ......................... . a <br /> Address----_-------------------- <br /> -- ---------------------------------------------------------------- <br /> Contractor's Name-- ----­------------------•-••---------------------------,-- ------------------------------- -------------------------- Phone................................... <br /> Installation will serve: Residiince)Q' Apartment House F <br /> Comm e-rc.al ❑ Trailer Court El Motel ❑ Other El <br /> ------ --- --------- <br /> Number of living units: __/---- Number of bedrooms ----O—Number of baths LZ--- Lot size ------- ----- --------- <br /> Water Supply: Public 1111 E] Community system,[] .Private,S' Depth to Water Table -------- ft. <br /> Character of soil to a d�e- pfh Df 3 feet: San pI [-] Gravel F Sandy Loam Clay Loam EClay D <br /> Adobe j❑ Hardpan C] <br /> Previous Application Made: If yes,date./ .-(i5IIA-) No New Construction: Yes ❑ No a FHA/VA: Yes 0 No ❑ <br /> TYPIE OF INSTALLATION AND SPECIFICATIONS: <br /> �- 2­ ­fi_e_t')_'_ <br /> (No septic tank or cesspool permitted if pu-bf.c"sel'�w-e:Lrt.is"--available wAin00` <br /> Septic Tank: DistanC4from nearest wel(__��------Distance from foundation------- 0------Material---- <br /> --------/�----•- ---------•--- <br /> N I f c-'mpartmenfs-----------:z7n-------S."e----- _ Liquid de'p�h---------4. <br /> o'!of C ---- -----------Capacity...... <br /> ---------- from fo6ndation---------"0line.__-_ ? --- <br /> Disposal Field: Distance rom nearest well--.-6'4%--___Distance ------------Distance to nearest lot <br /> Number Pf lines-----------------;4__------------Length of each line-___---_-- --------.Width of trench----_---. {------_----- <br /> Type <br /> renc'h--------- <br /> Type of111 Ifer maferial-_AV'C�_ ----------Depth of filter material-._-----19----_---Total length-A--------------------/Zo <br /> ----------------- <br /> Seepage Pit: Dist'ance o nearest -----------------Distance from foundation--. ---------------Distance to nearest lot line--._---__------_ <br /> El Number of pits----------------------Lining material---------------- ---- Size: Diameter-----------------------De' th <br /> I - material_--.---_-----_------_-._----__-..---. <br /> p <br /> Cesspool: Distance from' nearest well-------_;...77stance from fo7untla`fion�--------------------Lining materia,------------------------------------- <br /> A �10 4, <br /> Size: Diateter----------------------- ----------/-D th-----------------------------------.,4--------------Liquid Capacity------------_-------•--..gals. <br /> I!I <br /> Privy: Distance rom nearest well-A---------------- -----------------------.-Distance from nearest building.-----------------------_- <br /> --------------- <br /> Distance. �o nearest lot line--4. ------ <br /> ------------ ----------------------------------1-11------------------------------ <br /> ------------------------------------------.------------ <br /> ---------------------------------- ------------------------ <br /> Remodeling and/or repairing (doscribe): ------------------------------------ ----------------- <br /> do -------------------------------------i ------------------------ <br /> - <br /> I-------------­------------- <br /> -------------­-------------------------------------------------------------------------------------- <br /> !IG <br /> --------------I------------------------- ----------------------------------------------------------------------------- ---------------------------------------------- -------------------­ <br /> ------------ ------*------- <br /> -------------------------I--------- ----------------------------------- ---—----------- ---------- - <br /> -------- ---------------------------------- <br /> I hereby certify Wat I h �ve prepared this application and that thework will be done inaccordance with San Joaquin County <br /> ordinances, State lawsJand rules and re ations of the San Joaquin LocallHbalth <br /> {Signed)------- Jr, X <br /> _(Si - -- -------------- <br /> ------------ 471-� )nfractor <br /> -------------------(Owner and/or Contractor) <br /> ------- -------------------------------- -------------------------------------------------- ------ ----------------------- - - ----------------- <br /> - J--------- <br /> By: ----------- I <br /> (Plot lo location of system in relation to wells,.,buildings, etc, can be Placed on reverse side). <br /> IIN FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED 1340Y DATE------ -------- <br /> REVIEWED BY---------------i 0 Al- -C—------------------------------------------------------------ <br /> --------- ---- ---------- ---------------------------------------I--- ---------------------------------_ DATE---------------- <br /> BUILDING PERMIT ISS.UED-Af---------I----------------------------------------------f -------------------------------------- DATE--------------------- <br /> 6-o*-rn­ffi9Aa-rrWs:_ — <br /> Alterations and/or re t ----------------------------------------------------------------------•--------------- <br /> ---------------------------­ --------------------1111 <br /> --------------------------------------------------------------------------------------­­­-------------------------­--- - ---------------_---------- <br /> ------------------------------ ---------------I----------------------------------------------------------------------*------------------------------*--------------------------- <br /> -_-------------- ------------------- <br /> -------------------------------- -__....---.111 <br /> ------------------------------------------------ ---------------------------------------- -I------------------I---------------------7-------------------------------------------------­-------------------- <br /> ------------------- ------- <br /> --------------------------- ------------------------------------------------------------------------------------------------- ----------------- -------------- <br /> FINAL INSPECTION BY:.1__;---�__i --------------------- Date--- ------- <br /> 1 : . SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 730 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> RE—MED B-59 F.P.CD.2M 6.60 <br />