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FOR OFFICE USE: <br /> -------------------------------------------------- -- <br /> APPLICATION FOR SANITATION PERMIT Permit No. __ r •1 <br /> ---------------------------------------- {Complete in Duplicate) ` <br /> ----------------- Date' issued --------- -- -- - <br /> ,This Permit'Ex fres 1 Year'From Date Issued " <br /> Application is hereby rr_ade 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 /> t ' --------------------------------- <br /> -JOB ADDRESS AND LOCATION-- -------------- <br /> ----------------- Phone.... - ---- <br /> J <br /> Owner' Name------l. --:_ .......... <br /> ------------------------------------------------------ <br /> Address-----------Ampv/f•---- - Gy/ -------------­------------ -------------=-••----------------,------------------- <br /> Contractor's Name-------------xe-re �'/ Q ' ----------------- Phone...----•...._.___:_--------------- <br /> t Installation will serve: !Residence keApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> I � <br /> 6 Number of livin" units: _/___ Number of bedrooms �-- Number of baths f___ Lot size __rry�__x---- -------•-----=--•-------•-----•- <br /> 9 i ... <br /> Water Supply: Public system❑ Community system [t�'rivate ❑ Depth'to Water Tableft. <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel ❑ Sandy Loam ❑ Clay Loam El 11Adobe� E]ardpan <br /> { <br /> Previous Application Made: fif yes,date____________________} No New Construction: Yes 2"No ElFHA/VA: Yes[ � Na ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:, <br /> (No septic tank_or cesspool perr'itfed if public sewer is available within 200 feet.) , <br /> - - - . <br /> Septic Tank: Distance from nearest well____^�____--.Distance from foundation-----1*4-..__--Material___G__ --------------------- <br /> []� : .No. of compartments-----,r�------------------Size��•---.x-��-------Liquid depth--_-j1_4----------------Capacity._60"--------- <br /> 1. , b / <br /> l Disposal Field: Distance from nearest well_-_"r--_ __.Distance from foundati n._.� __-______-Distance to nearest lot line__i+�/ <br /> f •�'♦ Width of trench_ <br /> [� Number of lines----- - --- -- Length of each line---- ------------------------ ----•----------------------- <br /> - <br /> ---------------------- <br /> T �e of filter material j ��rt ---Depth of filter material__/?!�__--:_____Total length___f�r_1_____________________ \ <br /> v p I�s� - 4 <br /> _ h _ . <br /> Pit: Numabee of n+ares ell_-_' _-________Distance #rom foundation--- <br /> Seepage Q__....- Distance to nearest lot line ____________ (� <br /> .�> . <br /> Ir <br /> s <br /> l p Lining maternal__ � 1 _--Size: Diamete-r__ _-,:Dep#h- -------------- <br /> Cesspool: - . Distance from nearest well------------- Distance from~foundation--------------------Lining material------------------------------------- <br /> ❑ Size: Diameter--------'-----------=------- ------- Depth---•=-------_• -'-- ----------- -----------------Liquid Capacity `..gals. <br /> ' t t `• - G <br /> Privy: Distance from nearest well----------------------------------------- ------Distance from nearest build. <br /> ing---------_-,-----------•------------------ <br /> i ❑ .., Distance`to nearest lot line - "..� .,-- - �----- --1- _ ---_------ -� '�` <br /> --•----------------- <br /> �/ ---•---�------•-•--------•-•----- <br /> Remodeling and/or repairing (describe):--- -----�G �.�-��'�-`���-•----------�=------ <br /> # _ ---- <br /> __________ __________________________,_________-________.__________.________.-..__________. <br /> ; _ I - F <br /> --------------•-------------=----------------------------------------------- ------- ----------•------•----------------------. ---------•---------------------------- <br /> -------------------------------------- -- <br /> { I':hereb _certify that I have --reparegd this application and thaat the work will be-d-- -----_core <br /> Y y. prepared PP done-in with San Joaquin County <br /> ordinances, State laws"and rules and re ulations of the,San Joaquin Local Health District. <br /> (Signed) ------------------------------------------ ,.�-_i Can rent or <br /> gned ,;. <br /> :__-------- = <br /> (Plot plan, showing size of lot, location of sys m rrenonto wells, buildings, efc., can .be placed an reverse side). <br /> FOR DEPARTMENT USE ONLY'. ; <br /> APPLICATION ACCEPTED BY__��y._{.C_:_G~� p _____ DATE_____ ^�_ _ -� --------------------- <br /> _ -------- DATE--------------------------------•---••-•------------ <br /> REVIEWED BY-------•------------------- ---- <br /> BUILDING PERMIT ISSUED:-------------------------------------------- ---------.-�------------------ -r•- DATE = <br /> Alterations and/or recomm`end'ations:__f/ - - - -- - - /-----'ice ����`�- `' ---�` <br /> n __________ ___________ ----_----______ ______________________________________________ ____________________ <br /> ,.� � 9 -=----------------------------------- ----------- <br /> _ _________________________________--------------------- <br /> ----------- <br /> ------------------------------ <br /> __________________ <br /> - ------------ ---- ------,-•------------------------------:----------------------------- ------------------:::::------ <br /> -----------=-- - -- <br /> ION-BY -FINAL INSPECT 'Date---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South Amarlcan Strreet 300 West Oak Street 124 Sycamore Street 205 Wert 9th Street <br /> Stockton,California Gocil,California Manteca,California Tracy,California <br /> I•Y' E6.9 REVISED 8-59 r.F'.GO.1M 6.60 <br />