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FOR OFFICE USE: <br /> -I—(1 3------ <br /> --------- APPLICATION FOR SANITATION PERMIT Permit No. ..../........... <br /> -------------- --------------- (Complete in Duplicate) Date Issued ---- <br /> ------------------ <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. AL P 110 C IZCI- — IS+- PL 111C-EF SO. <br /> JOB ADDRESS AND LOCATIQN... '�� - _k ..r-- -----r - <br /> -----E&I&OnA...... ---S__1VE- <br /> ------------- ------------- ------&Z... <br /> Owner's Name-----1"..11A ------Vq. �P-_AAJA----- Phone 14-0.. <br /> ------------------------------------- -------­­-------------------------------------- <br /> Address........................................rs_oWi.O-------------------------------------------------------------------------------------------------------------------------------------------------- <br /> Contractor's Name--- �)AALP,1-6_k...... .......................................................................................... Phone---j-4°--k1-_%-6 P 7...Installation will serve: Residence ;5 Apartment House ❑ Commercial 0 Trailer Court [] Motel 0 Other [3 <br /> Number of living units: A__Number of bedrooms Number cif baths ----I--- Lot size -------V--k------ _--------_------ <br /> Water Supply: Public system n Community system F Private � Depth to Water Table _A0_ ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel 0 Sandy Loam 0 Clay Loam [3 Clay Cg Adobe X[ Hardpan 0 <br /> Previous Application Made: (If yes,date-------------------.) No % New Construction: Yes F] No ( FHA/VA: Yes 0 No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted-if-public sewer is available within 200 feet.) <br /> _4 <br /> Septic Tank: istan <br /> D from nearest well------- -----Distance from foundation______ ________--Material_____ _______________-------------- ----------- <br /> ❑ No. of compartments--------- -- ----Size---------------------------------Liquid depth--------- ----------- Capacity----- ---------------- <br /> Disposal Field: Distance from nearest well-._-__--__Distance from foundation.....!:1,.0----.____.Distance <br /> Distance to nearest lot line---- <br /> 11 <br /> 19 <br /> Number of lines..............I------- ------------Length of each fine-------------3-T.............Width of trench------------�&Y---------------- <br /> lots <br /> � <br /> • <br /> Type of filter mate ria -_-_Depth of filter material--------L6----------Total length_______ ---_----------3-S--6-------- <br /> Seepage Pit: Distance to nearest well-----tao-1--------Distance from foundation................Dist to nearest lot line__1_4"_ _.1--- <br /> 7 <br /> 19 Number of pits--------I------------Lining mate ria Aft_1d.____.Size: Diameter- ?... <br /> ..------------Depth----------------1 .6----------- <br /> Cesspool: Distance from nearest well-------_-----_-Distance from foundation--------------------Lining material-____________________-_--_-__-______ <br /> SizerDiameter------------------------------------Depth---------------------------------- ----------------Liquid Capacity----------------------•----gals. <br /> Privy: Distance from nearo.5t well,__._--. __ „_____---_- _--_--___Distance from nearest building_________ <br /> tonearest lot line------------------------------------------------------------------------------------------------------------------------------------------- <br /> Remodelin <br /> g and/or repairing (clescribe):_--------AA-4--------Ln--------Q_XAZ4_0�1-----------S.Y.4.Tk' -,------------------------------------------------ <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 9" <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. - <br /> (Signed)_-------_------D-0A.,--- .........k--- ------ c---------------------------------------------- (0 ner and/or Contractor) A. <br /> "Itle)------------ .........---_ r <br /> By:................... ------­--------- -- -------- -------------------------------------- -------- ---- - <br /> C, <br /> _4 - --------- -- 7 <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 /> APPLICATION ACCEPTED BY------- ----------------------------_------------- DATE------ . . .... <br /> 10� ---- ------ ----------- <br /> f ----------------------------------------------- DATE-------------------------------------------.............. <br /> REVIEWED BY----- ------------------------- --- ----- - --- --- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE--------------------------------------------------------- <br /> Alterationsand/or recommendations:-------------- ----------------------------------------------------•----------........................................................................... <br /> ............ ............------------------------ --­-------------- ----------------------- ---------- -------------------------------------------------------------------------------............................. <br /> -----------------------------------------------­--­--------------- ------------ --------------------------------------------------------------------------------- -------------I----------- -----_----------- ------- <br /> --­--------------------- ------------------------------------------------ ---------------------------------------------------- ---------­------------- ------------------------------------------------------------ <br /> ---------------------------- ----------- ------------------------------­­............. ---------- ----------------­- -------------- ----------------------------------------------------------------........... <br /> FINAL INSPECTION BY:.. L/Vl_- -- --------- ......... ------------­---- Date--..- -----------­­------------------------ <br /> N 0 West J(OAQufN LOCAL HEALTH DISTRICT <br /> I <br /> 1601 E.Hazelton Ave. 3 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED B-S9 3M 3-'63 F.P.120. <br />