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� h--C.tadi c, r <br /> :-----'_ --------------------.- .-- ---. -- APPLICATION FOR SANITATION PERMIT Permit No. .... .: ...._. <br />-- --- -- -------- ----- -- ----- (Complete in Duplicate) <br /> -------------------------- This Permit-Expires i Year From Date Issued Date Issued ` ............... <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct a stallthework herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> P� �r <br /> JOB ADDRESS AN OCATIG' �Q- <br /> Owner's Name...-. <br /> �/_ <br /> --------------------•-------------------------------------------------------•--------. Phon --- O <br /> Address................. <br /> -�a <br /> ----- ------ -- ------... <br /> Contractor's Name.---_ --------- ----------- <br /> �,� ..._.._.Phone.... ...... <br /> L�. J <br /> Installation will serve: Residence artm nfi HousY-- --riNumber <br /> omrr� i <br /> p e al ❑ Trail Court ❑ Motel ❑ Other <br /> Number of living units: -_ er of bedroomof baths Lot size . Ij._r.-.?� f rif._ _ <br /> Water Supply: Public system Community systemate ❑ Depth to Water Table --47ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 0 Clay ❑ dobe ardpan ❑ i <br /> Previous Application Made: {If yes,date--------------------1 No ❑ New Construction: Yes ❑ Na FHA/VA: Yes ❑ No ❑ <br /> TYPE INSTALLATION AND SPECIFICATIONS: ; <br /> [No septic :.oa cesspool permitted if public sewer is available within 200 feet.) <br /> eptic k: Distance from nearest well-----------------Distance from foundation_---_----_-_.-..---.Material_---..--_----- .._..________....,,•.•..•_ i <br /> No. of compartments--------------------------Size----•--------------------••-----Liquid depth-------------------•----.-Capacity <br /> sal Distance from nearest well,14 /-.Distance from foundati --------------- <br /> . - ...Distance to nearest lot line.....__ <br /> Number of lines----/--- ..___ - Length of each lin o.-� of trench------ <br /> .p <br /> Type of filter materia _ - ._ Depth of filter material...- -------Total length-__- . ----------- ...-•-_ <br /> 10�I -4 Distance from foundation <br /> Distance to nearest well -E�__-----.D' to a to nearest lot line------ ... <br /> E� <br /> �� Number of pits--..l----------------Lining material- e. ----__51ze: Diameter--- --- --_------Depth----.. - 'r-..-- <br /> ----•- <br /> Cesspool: Distance from nearest well.---_____--_-.--Distance from foundation--------------------Lining material_'.--..--------_ + <br /> --------------- <br /> El <br /> Size: Diameter--------�-----------------------------Depth----•-----------••--------•------ ----------------Liquid Capacity Y-------. ----------------gals. I <br /> Privy: Distance from nearest well------------------------ ------------------Distance from nearest building.--_--.--:----..---_ <br /> Distanceto nearest lot line--------------- ------- -----------------------------------------------•-----------•-------•---...-----------------------------•--•--------- : f <br /> Remodeling and/or repairing (descri ---------------------------- <br /> 3 <br /> ---.------ ------------- -------------------- <br /> -----------­--- <br /> ---------••--------•-- •---•--•------- ---•-------- -- -------• --------- -------- <br /> -------•---- •-----. e <br /> a •- �....�..L.--------------••---------------------- <br /> .---•------•--------------•-••-------...----------------- •------••--°-------•-------------------------- -------------- ---------•------------------------•-----------------------•--•-•-•--••----------•----------- <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 , d rule and regulations of the San Joaquin Local Health District. <br /> (Signed)---- -------•....... ._JLC-._.: . Tj----Y.,.T.�L V 1-- -- ---- ----- ------•-••-----------•-------•---•• Contractor) <br /> J� <br /> •------- �/ .--------- Title <br /> ------------- <br /> (Plot plan, showing size of lot, location of system in relation to we , buildings, a ., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY ' <br /> APPLICATION ACCEPTED BY ------------------------------- DATE---------- <br /> REVIEWEDBY-------------------------------, -----------------------------------------------------------•••---•_. DATE-•-------- <br /> -----------�--- - <br /> UILDING PERMIT ISSUED-•---------------- .. - DATE----------------------- <br /> ------ <br /> Alterations and/or recommendations:-- - --�• �-- ___ e-( - ----- -- �- ----••------------ <br /> -----------•------•---- ••-------------------•-----•---- <br /> FINAL INSPECTION BY: — '....°" ? Date------ Z.- - ------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street ' 124 Sycamore Street 205 wast 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> E6 9 REWSEC 0.89 2M 8-61 ATLAS <br /> f <br />