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FFI <br /> i . --------F0 <br /> ---F R OE I SE: f _ <br /> gyp[ fJ <br /> '" �G - ' <br /> .� <br /> f APPLICATION FOR SANITATION PERMIT Permit No. <br /> _ (Complete in Duplicate) <br /> -------------------------- <br /> , <br /> -- m--- I This Permit Expires 1 Year From Date Issued 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 /> JOB ADDRESS AND LOCATION_' <br /> .._� �•-'�.- .-______ M. ` <br /> A ..... <br /> ;.. . <br /> Owner's Name.-----..-..�--"----�--'----J-"-•-•-- <br /> -•--------------------------------------- ------------------------------------------ Phone-,.................. <br /> Address-------- <br /> ........... •--------- <br /> 4x =' - �J <br /> �� <br /> Contractor's Name----••- -- j x� <br /> .. �`�. ..-_ - Phone <br /> Installation will serve: .Residence ® Apartment'House ❑ CommercialT�a er Court ` { <br /> ❑ ❑ Motel ❑ Other ❑ Q <br /> Number of living units: ._..--- Number of bedrooms .,..y-.. Number of-baths .-1__-- Lot size <br /> E3 <br /> � a <br /> - � �-------------- -----......---------•---- <br /> Water Supply: Public system 0 Community system Private ❑ (Depth to Water Table . -_ ft. ! <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Cay C] Adobe 63--Hardpan ❑ <br /> Previous Application Made: Ilf yes,date---------- - ) No v❑1. New Construction: -Yes �o ElFHA/VA: Yes ❑ Na ®�� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted,if:pubec sewer.`is available within 200 feet. i <br /> ` _ I ,! ) A <br /> �SPptic Tank: tDistance from nearest wall_..---_-_---/Das}an''ce from foundation-------------------.Materiel:- 4 <br /> compartments-----------4------=/_- Size------ Liquid depth------------------_------Capacity <br /> ' r , <br /> Disposal Field- Distance from nea.resttwelf _-�LQ._.Distance from foundation---.f-G_�_--..,_Distance to nearest lot,line_._...r ,•• <br /> + Number of lines--_-_-j!_•---, -- �-----_Length of each line------3.4-1--- -----•-Width of trench �- <br /> s� �... <br /> > 5 ,SI! ) s��P TYPe.. - ...te? material;4-4 -�-----.Depth of filter material-----(�------------Total length...__��:_ -:---•--••----- �k <br /> P 9 1 i Vl <br /> `o nearest well____ .mu---. •---Distance from foundation____.l'.�_......_..Distance to nearest 4line.--�_...-._ <br /> [] Number o <br /> See a Pit: �p(stance f'`its" ¥- f. <br /> -�` t <br /> ' P -------- Lining material.--��-----------Size: Diameter----��-----•---..:Depth-!�°•�---�? <br /> #' <br /> Cesspool: Distance' ram nearest ell..-------------Distance from foundation-------------------Lining ma Basal .........----------------------- <br /> El <br /> ----------- ----- .. <br /> P <br /> ❑ Size:.Diameter-------•---- Depth------------------- gals. i <br /> Privy: ,of,;,�r?." r_ p tY= .......... <br /> Distance from nearest well--------•---------------•--- ------_--------•.-.,,Distanice fPom nearesf�building---- .,•-----+�----•-� ------ _ <br /> ❑ Distance to nearest lot line------------••-----•------------------- � +� � �. <br /> N. <br /> ..------•------- <br /> Remodeling'and/or--r-e--p--ji-r--i-6g (describe):__-_--_6- P�--_ pL - - E�j�, �,ti / <br /> •----------- <br /> ­----------- <br /> -----------------:.--•------------------- � <br /> -••-----_------=--'---•-^ 7I7 <br /> �� -.tir k-'yam---------------•----._-------•------•-----•••-- 1..._.......----....---...-----•'--'--- F <br /> I hereby certify that 1 have prepared this application and that the work will be done m accordance with San Joaquin County 1 <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> f <br /> �. ���� - --------- <br /> (Signed)---:: _......: -.. �'""`�t't (Owner end/or Contractor <br /> ' ------------------•(rtlej -" __ - u <br /> (Plot plan, showing size f lot, location of system in relation to wells, buildings, etc., can be placed on raver side). <br /> FOR DEPARTMENT USE ONLY } <br /> APPLICATION ACCEPTED BY----.. <br /> ------ DATE <br /> _.____9 y ------6 - �--------------- <br /> REVIEWED BY--.. "----------- --- -----------••---- <br /> DATE <br /> BUILDING PERMIT ISSUED------------•-------- --•-- - <br /> __._. -.-_: DATE--A...... .//....... '^-------- <br /> Alterations and/or recomme dations---------------- ------------------------------ <br /> C �p <br /> •...............................' ------------ ---.._-_-- _....__-...-_-_._.---__•_•_---....-- -- •----•------ -_..... <br /> .............. •---••-------------- ......... <br /> .I----------------• ------------------------------------------------------------ ...... <br /> i -- 4 <br /> -------------------••_------_--.---'------`-- -^.------ <br /> FINAL INSPECTION BY:--------I........ - ------- Date---- --- -- ----------------------------------- <br /> -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South Ame/icon Street 300 West Oak Street 124 Sycamore Street <br /> Stockton,California205 West 9th Street <br /> Lod[,California Manteca,Col[fornfa Tracy,California <br /> ES 51 REVISED g-59 Yid 6-61 ATLAS <br />