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FOR-OFFICE USE <br /> /------- No. <br /> -- -------�/ Wc APPLICATION FOR SANITATION PERMIT Permit <br /> -------- ----------- ----------------------------------- (Complete in Duplicate) Date Issued <br /> - <br /> -------------------------------------------------------- <br /> - --------------------- ----------- ------y--------------- <br /> This Permit Expires I Year From Date Issued <br /> Application is herebmade to the San Joaquin Local Healfh 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 /> ,7 ------ <br /> -------- <br /> Phone------------------------------------ <br /> Owner's Name.--- <br /> 47 <br /> -------­--­---------- <br /> &------- <br /> Address............ <br /> P oneWl­-k� <br /> ------------------------------ h <br /> Contractor's Name---- <br /> Installation will serve: Residence ❑ Apartment House [I Commercial. Trailer Court [-] Motel [] ' Other [I <br /> I <br /> lNumber of living units: ._-_"__- Number of bedrooms -------- Number of baths -------- Lot size ------------------------------------------------- <br /> ---------- <br /> Wafer Supply: Public `system Y Community system [] Private E] Depth to Water Table/6-- ft. <br /> Sand F Sandy Loam [I Clay Loam [I Clay C] Adobe Hardpan 0 <br /> Character of soil to a depth of 3'feet: ] Gravel El K �Z <br /> Previous Application Made- (if yes,date--------------------)" No New Construction: Yes)( No ❑ FHA/VA: Yes E] Nc, <br /> .x <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Ie--- <br /> Se;K' Tank: Distance from well.-'-A/We,Distance,f.rom.foundation--- •--------------M,teri,01 <br /> Ca otic ...ePO--------- <br /> D --------C <br /> No. of compartments------ Z-------- ---Size-, ­( --4,f <br /> j-jnn-5�---Liquid clep�h <br /> I ------Distance to nearest lot lief"_,6---------- <br /> DisVpl Field: Distance from nearest well---//9A)&D;stance from foundation---.!...I----- <br /> Number of lines----------/------------------------Length of each line..._ 17-6 --- - Width of trench____ <br /> Number ---------------------- <br /> .1 ---Depth of filter material_"__ ----------Total length-------44----------------�/ �s <br /> Type of filter material____.;20.IC. & V - <br /> Se pa Pit: Distance to nearest well.___IV foundation_______.._._le- ------­Distance to nearest lot liine,f--------­ <br /> jb*48--Xistante from founclat --- )��-----�Depth---0------------------------- <br /> CX Number of pits----/----------------Lining- m.aterial--/%Ft,415�....Size: Diameter-4Yii0o <br /> from foundation--------------------Lining material_""___.._."___________________________ <br /> sspool Distance from nearest well-----------------Distance iIs. <br /> [D Size: Diameter.-------------------------------------Depth---- ------------------------•------------------------Liquid Capacity----------------------------ga <br /> ----------------Distance from nearest building------------------------------------------ <br /> Distance from nearest well--------------------------------- <br /> Privy:I. - -------------------- <br /> Distance to nearest lot line.-/-"___________________ *--------------- <br /> Remodeling and/or repairing (describe);---------------------------------------------------------------------------­­------------------------------------------------------------------------- <br /> I ---------------------------------- --------------------------------------------------------------------------------------------••----------------•------------• <br /> I----------------------- <br /> ------------- ---------------------------------------------------------------I------------------------------ <br /> ------------------------------------------------------------ ------------------7----------­--------------- <br /> -- -----------------------------------------------------------------I-------------------- <br /> ------------------------ ------------------------------------------:---------------------------------------------------------------- <br /> I hereby certify tha't I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws 1 11 of the San Joaquin Local Health District. <br /> and rules egu a ions <br /> ____--..-___{Owner and/or Contractorl <br /> {Signed}----•.------ - --- --- --- - -------------- -------------------------------- - <br /> • <br /> --- ------------- <br /> By:­------------------------------------------------------------------ <br /> (Plot plan, showing size of lot, location of system in relation to Wells, buildings, etc., can be placed.on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED -------------------------------- -------------- ---------------- ------- DATE------ ----------------------------- <br /> REVIEWEDBY---- --------------------------------------- -- -------------•------------- ------------ ---------------- ---------------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED----------•------------------------------- -- ---------------------------- DATE.-------------------------------------------- -------------- <br /> I Alterations and/or recommendations:----------------------------------- -- ---------------- ---------------------------------------------------------------------------­----------­----------- <br /> ----------- ----------------------------- <br /> ------------------------------------------------------------- ----------------- -- ------------------------------------------------------- ----------------­ -------- <br /> --------- ------------------------------------------------- ------ - ---- ---------- - ­­-------------- --------------------------------------------------------I-------------------------------------- <br /> ------------------------------------------------------------------------------------- --------------- ----------------- <br /> ---------------------------------------------------- - ----- ------------ ------ T <br /> ---------------------------------------- -- A---- - - ----------- -- --- ---I- ---------- --------------------------------------------------------------------------------------------------------------------------- <br /> --- --- ----------- ---- Date---- /------------- -------------------------------- <br /> FINAL INSPECTION-'BY:- - ------ ---- -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Strout 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> r.S.g REVIBSD B•59 <br /> r^rQ.2M 6-6G <br />