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VZl�OFFICEUSE; <br /> APPLICATION <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No. <br /> ------------ ------------------------ ---------- ----- <br /> (Complete in Duplicate) Date Issued <br /> ------------------- ------------------ ----- ------------- This Permit Expires I year From Date Issued construct 0and install the work herein described. <br /> Application is hereby made to the San Joaquin Local Health District for a permit to cons .A-e, <br /> 0 compliance with County Ordinancr—No. S49. Roe. G k <br /> This application is made in <br /> c -2- -----•---•--•••------•--••----•---------•........... <br /> -_ _?�....q-t-fp------A--------- ----�1 <br /> JOB ADDRESS AND LOCATION.......PN4., Phone------------------------------------ <br /> Owner's Name---------%-U-t------- "I JQ--------------•----------------------- ----------------------------------------- <br /> ..�! ' ........................................................................... <br /> Address...........RJ­­_Z�—------ Phone_...---------------I....... <br /> Contractor's Name —----- . ...... -:.A---- - ----- <br /> Installation will serve: Residence a Apartment House q F.9mmercial El Trailer Court [] Mote[ [] Other 0 <br /> 35;� NiAer of baths---A---- Lot size -------—5--'0---C ---------- <br /> Number of living units.. __1_.- Number of bedroams <br /> i7 I— - — __- D, Water Table �10- ft. <br /> Public <br /> S, n� C] Community system [] Private NZ Depth T <br /> Water Supply: Pu6 ystei ClayLoamO Clay [J Adobe gL Hardpan [] <br /> Character of soil to depth of 3 feet: SandE] Gravel [] Sandy Loam C]Construction: Yes K No ❑ FHA/VA. Yes E] No�R <br /> Previous Application Made: (if yes,date.-_.."______________) No C& Now <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public I sewer is available within 200 feet.), <br /> Septic Tank: Distance from nearest well----5-0 Distance from foundation-----I--0--------�Maferial---t_4 <br /> No. of compartments---------Z-- .__.-------Size__ Liquid d,p�h------ ---------capacity_.t---- <br /> Disosal Field: Distance from nearest ell.-SO-k_______Distance from foundation--__-1-6---------Distance to nearest lot line <br /> Number of line----- -------- ----Length of each line-------b0_1----i--- <br /> Type <br /> 0---------Width of trench --- ---------•--•A <br /> ---- -Aw <br /> jai ------------Total length.------ . ...... <br /> Type of filter material.j5p__1C6_U,___Depth of filter mater ....t�5 <br /> Seepage Pit: Distance to nearest well-----------------------Distance from foundation-------............Distance to nearest lot Number oline___..___-___.____ <br /> f pits---------------------Lining-------Lining material---------------------- Size: Diameter-----_----------------Depth------------ ------------------- <br /> El e from foundation-------------- ----1ining material-----------------------------------e <br /> Cesspool: Distance from nearest well-----------------Distanc -Liquid Capacity_------------- -------_.ga <br /> E]r Size: Diameter--------•--- ----------------------- <br /> Depth---------------------------------------"----------- <br /> Privy:', Distance from nearest well -------------Distance from nearest building------------•--------------------------- <br /> ------------------------------------ ----------------------------- <br /> ---------------------------------------------------------------------------------------------------------------- <br /> ❑ <br /> Distance to nearest lot line <br /> ------------------------- <br /> Remodeling and/or repairing (describe):------ -------------------------------------------------------------------------------------------------- ----------------------------- <br /> ------------------------------------------------------------------------------------------ <br /> ---------- ------------------------------------------------------ ------------- . . ....... <br /> .... ------------­---------------------- ---- <br /> .............. ------ -----------�­------------------------------------- --ii----------------------- ..... <br /> ____________________r___.________------ --------- --------- <br /> -------------------------- ---------------------------- ----I---------------------I--------- <br /> --------------- <br /> - <br /> -------------------------- <br /> ---------------------------- <br /> lihereby certify that I have prepared this-application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulati'on$ of the San Joaquin Local Health District. <br /> -----(Owner and/or Contractor) <br /> (Signe�d)__ <br /> .......... ............ ------------------------------ ------- --"--------------•------------------------ - <br /> i <br /> - ---- <br /> I By:-------••----------•------------------- �_'6�6tion to wells, buildings, etc., can be placed on reverse side). <br /> (Plot 'Ian. showing size of lot, location �f sy'terqJ'n_ <br /> 0. S <br /> p <br /> FOR DEPARTMENT-USE ONLY <br /> Al <br /> l DATE <br /> -------co-A----------------------------- <br /> - A c <br /> APPLICATION ACCEPTED BY. DATE------------------------------------------------------- --- <br /> REVIEWED By.---------::!;_­----------------------- ------- <br /> DATE----------- <br /> BUILDING PERMIT ISSUED---------­----------- <br /> _- --ti--- --- --- <br /> 5 2 <br /> Alterations and/or4recomrp <br /> com <br /> ---- - ---- ----- -- ------- <br /> ---------- --------- - ----- <br /> 71—V-�........ . ------- --- ------ <br /> ----------- - ------- ............................... <br /> - <br /> ---------f............................. ---------- - --- -------- ------- ---- --- - ---- ---------------- --------- ---------------- <br /> -------------------------------------------------------------------- <br /> -----------;----------1-------- --I——-----------------------I----------- ------------------------------I -------------------- -----------------------------------------------------------------------­------ <br /> --------------------------------- <br /> -------------- ------ <br /> ..........------------------------- ........ ...... ----------- <br /> -------- ------------------­---- <br /> -------------- ---------------- ----------------- <br /> FINAL INSPECf1_0_N1Y'- <br /> SAN JOA91JIN LOCAL HEALTH DISTRICT <br /> 300 Went Oak Street 124 Sycamore Street 205 West 9th Street <br /> 130 South American Street Lodi,California Manteca,California Tracy,California <br /> Stockton,California _4T4 <br /> ES 9 REVISED 8.59 2M 5.62 ATLAS <br />