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5R0__ <br /> F— <br /> FOR OFFICE USE: <br /> ------ - Permit No. <br /> --------------------------------------- APPLICATION"FOR -'-SANITATION P MIT <br /> -------------- <br /> (Complete in Duplicate) <br /> .. ... Date Issued <br /> This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and 'install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> ---------- <br /> JOB ADDRESS AND LOCATION.X??�! -----------------------0_ -----------------­------------------------------------------------------------- <br /> ---------------------------- --------------------------------Phone-..---.-.-,------------------------------- <br /> owner's Name- --------­-- ----- ----- ----------- <br /> ----------a��-----2-,Z_ <br /> Address----------- ------------------------- --- - ---------------------------------------------------------- <br /> Phone----------------------------------- <br /> Contractor's ------------- -------------------------------- -------------------------------------------------------------- <br /> Installation will serve: ResidenceJE Apartment House El Commercial E] Trailer Court [I Motel [I Other [I <br /> Number of living units: Number of�bedroo4s%%4____ Number of baths -------- Lot size ---------------------------------------------- <br /> Water Supply. Public system El Community system ❑ Priva 11 fia.,M Depth to Water Table ft. "A <br /> Character of soil to a depth of 3 feet- Sand Grav6I ❑ Sandy Loam E] Clay Loam El Clay ❑ Adobe J�] Hardpan <br /> t 1lA <br /> s,date- _-A No F1 New Construction: yes [] No [] FHA/VA-. Yes E No <br /> Previous Application Made: (If ye .. ........ <br /> TYPE OF INSTALLATION AND SPEC IF I CAT,IC t,5: <br /> (No Septic tank or cesspool permitted if pu6.[ic,s9*qrj-s.ava',ila6le within 200 feet.) <br /> At , 7 ---------- ----------- <br /> 'Distance <br /> Septic Tank: Distance from nearest well, _..__---- from foundation--Z............Ma -------- --------- <br /> No. of compartments---:2�_ 6----­_Liquid depth.... <7------ -------_Capac;fy--4 ------- <br /> ----------- ---- -- ------L I <br /> liney__.._._____ <br /> p <br /> Field: Distance from nearest weii.;.e..........! <br /> [Distarlce from fou dation.-/-A r...-----..Distance to nearest lot line��t <br /> Number of lines-----3 4 ---------_L'-*�ngt of each line__ -------------------Width of trench------�.-Y--------------------- • <br /> - <br /> Depth�of'filter mate ri ------ Total length-__ ------------------------------ <br /> Type of filter <br /> well_ <br /> Seepage Pit: Distance to nearest w Distance from, fou ./49V is <br /> Number of pits.j--------- -------Lining rnaferi ----- -- <br /> ndafion__ -------- Dfance to nearest lot line----------------- <br /> "Z ---Size: Diameter__�_I"' .-- ----Depfh_,1-_X7/--------------------- C'N <br /> - <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_-__--_------______-._._-----._____ <br /> Size: D�ameter__.---------------------- ----------------------------------------------------Liquid Capacity- .-------------------------gals. <br /> ❑ <br /> Privy: Dis+ance from nearest well...... -------------------------- - -------------Disfance from nearest building____._.___..___.__________.__..--------- <br /> 0 Distance to nearest lot line------------------------- --------- ------- -------------------------- ------------------------------------------------ ------------------ <br /> ---------------------------------------------------- <br /> Remodeling and/or repairing (describe):-------------------- =------------------------------_- -------------------------------------------- <br /> ------------------------------------------- ----------------------------------------- --------------------------------------------------------------------------------------------------r--------- <br /> ------------------------------------- ------------------------------------------------------------------------------------------------------------------------------ -----------------------------........ ---------------- -- <br /> ---------------------------------------------------------- -- - <br /> -- <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 laws, and rules and regulations of the San Joaquin Local Health District. <br /> [Signed)____ . J,- ---------T5 ------------------- -----------------------------------------------------I--------- -(Owner and/or Contractor) <br /> -------------------(Title)---------------------- ---------------- --- ----­------------ <br /> - --- -- ---- ----------- - --- ----- - -- --- -- - ---- - - ------- _--------- <br /> By:----------------size_o-f--lot.--location-_of-_system- - ..in-_relation-- - -t-o-_wells buil.clings, etc., can be placed on reverse side). <br /> (Plot plan, showing <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED ----- -- -------------------- ---------------------------------------- DATE___1__-_1-------4---------I-------- ---- ----------------- <br /> REVIEWEDBY----------------------------------- --------------- --------------------------------- ------------------------------------- DATE-----.--------------------------------------------------- <br /> BUILDINGPERMIT ISSUED__-------------------------------- ------------------------- ---------------- DATE------ ----------------------------------------:'--------- <br /> Alterations <br /> ---------------------------------------:'---------Alterations and/or recommendations:--------------__------------ ------ ------ - ----------------------------------------------------------------------------------------- -------------------- <br /> ------------ - ------------------ ------------------------------------- ------------------------------------------------------------ ------------------ <br /> ------------- ------------------------------------------------------------------ ---------------------------------- <br /> ---------- ---------------------------------- --------------------------------- ------------------------- <br /> - <br /> ------------- ---- ------------------------------------------------------------ <br /> --------------------- <br /> --------------------- ------------------------------------------------------------------------------------------------- --------------- ----- <br /> FINALINSPECTION BY,,'�--- ----------------------------- Date------- ; 7--- - ---------- - ---------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxelton Ave. 3oo West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lod!,California Manteca,California Tracy,California <br />