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&,FOR OFFICE USE: <br /> tr) <br /> --- -------------------------------------- <br />--------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .4�n.5-E'3 <br />------------------------------ -------------------------- (Complete in Duplicate) Date Issued ---- <br /> -------------------------------------- ----- This Permit Expires 1 Year From Dats.issued <br /> Application is hereby made to fhe; SanJbaquin Local Health District for a permitto_c <br /> �' onstrucf-and-s�-nstill-tho-work-herein described. <br /> This application is made in compliance'�-wfthCo-unty Ordinance No. 549. <br /> 'JOB ADDRESS AND L CATION-Kh..----7--pEwm fflzi:�B <br /> Owner's Name........ <br /> / , ------ ...............-------------------------------------------------------------.... Phone.................................... <br /> Address......�W-E-:=L T f\j <br /> ...... ......... ---.]RC <br /> -- --- ---------------------------------------------------------------------------------------- <br /> Contractor's Name...__L 5DB... <br /> - ---------- <br /> ------- ......j........................................... Phone........................... <br /> House E] Commercial [I Trditt—,rCourt []. 7Motel E] Other [I <br /> Installation will serve: Residence [q-"Apartment <br /> Number of living units: --- Number of bedrooms-3. Number of bath Lot size ---145��A-E ------ <br /> Water Supply: Public system El <br /> Community system F] Private 2r--6evth,.-ro Water Tableq <br /> Character of soil to a depth of 3 feet: Sand [] Gravel Ll Sandy Loam �Ciay-Loam E] _Play [3 Adobe 0 Hardplah 1 <br /> Previous Application Made: (If yes,date____________________) No N. ruction;Yes No FHA/VA: Yes 0 No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspo6I-p&mitted_if.public sewer is ,a..I <br /> ce n <br /> Septic TPA: Distan from nearest D <br /> is <br /> ta fun a" <br /> 1�r No. of compartments_____7------—---------Size- Liquid depth________ -----------------Capacity---,/-:� <br /> ...Z.e <br /> Disposal Field: Distance from nearest well---- Distance f _:......Distance to nearest lot line-5._._._.. <br /> Number of lines____ /-----------Len g Of 'O.Width of french .............. <br /> Type a of filter material... Depth of -":- -length..._... <br /> -----A9.0. <br /> -,�length... ---------A9.0 <br /> ----Total .... ------ <br /> Seepage P, Distance to nearest well-10-0 <br /> - -------Distance fr tiori ......Dist nce to nearest lot line_____`- <br /> Al�, <br /> 'Number of pits--------/---.._._---Lining mpte: rial--- ize: Di me4e Depth------ .......... <br /> Cesspool. Distance from nearest well------------: ...Distance fr in ation--------------C-Lining n1aterial------------------------------------- <br /> Cl Size: Diameter------------------ ----Dept h---------.----- -- ------------------------ Licli�id Ca'p76city1'..-.---....................gals. <br /> Privy: Distance from nearest well_____________________________________OF-91strice-ftorri-nearest building______-__-...-_...-.._..._.______.._.-___-- ; <br /> ❑ Distance <br /> uilding-----------------..................------ <br /> Distance to nearest lot line------------- --------------- <br /> --------------------- ----------------------------- <br /> Remodelingand/or repairing (describe):-------------4--------------- -------------------------------------------- ---------------- .......----------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------­...... ------------r <br /> ---------------------------------------- -----7;�:---------**------------------------------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------I'll--------:n......... ------------------------------- <br /> ------------------------------------------------------------------------ " . t <br /> -----I-------------------........,------------------------------------------------------- 1-----::��------------------------------------- <br /> I hereby certify that I have prepared, this. )plicafion and that the work will be done in accordance with San Joaquin County <br /> ordinances, Stale laws, and rules nd regulations of the San Joaquin Local Health District. <br /> --- -- --- -- - ------------------------ ----- I------------------(Owner and/or Contract, <br /> ...........=...... <br /> ................w.............. <br /> . ................ - -------------------------------------------•----------------(Title)------- ---------------------------------- -- ------- <br /> .4- — \ ,( <br /> (Plot plan, showing size of rof. locaflon of syi%m 4w relation to wells, buildings, etc., can be placed on reverse side). <br /> 7 <br /> FOR DEPARTMENT USE ONLY -K- <br /> APPLICATION ACCEPTED BY---- 80-= - ---=--`------=----------•--._..._..--••---•---------- -- -------------------- DATE ------- <br /> REVIEWED $Y.. -------- ---- <br /> ------------------- -------------------------------------------------------------------- DATE------------ ------------------------------------- <br /> BUILDINGPERMIT ISSUED...---- --------------------------------------------------.......................I--------------- DATE--------------I----------------------------------------------- <br /> Alterationsand/or recommendations:-,-------------- ---------------------------....................... ---------------------------------------­..............................................I... <br /> --------------------------------------------------------------------------------- --------------I...........................................................................--------------------------------------- <br /> .............--------------------------------------------- -------------- ------------------------- -----------------------------------------------------------------1-................................................... <br /> --------------------------_-­-------------------- --------- ---------------- -------- --- --- - ----------------------:---------- ......--------------------------------------------------------------------- <br /> ------------------ ------------------------------ --------- - ----------------- -- ----- ------- --- ----- -------------------------------------------------------------------------------------------------- <br /> FINAL INSPECT! <br /> ----- Date._t -------------------------------- ------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8.59 2M 5.62 ATLAS <br />