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FOR OFFIC4 US�-- Permit <br /> 1l! FOR <br /> - No. <br /> 2" -------------- <br /> --- -------t <br /> - t APPLICATION FOR SANITATION PERMIT <br />------------_-_-_-1 -------------- <br /> --A-----------)------------------------------ <br /> --------U (Complete in Duplicate) Date lssuec'-5�� �k-.(# <br /> . <br /> ----- --------i --------- <br /> This Permit Expires 1 Year From Date issued d. <br />------------- <br /> Applica-tion is hereby made to the San Joaquin Local Health DistrNo.ict for a permit to construct and install the work herein describe <br /> This application is made in compliance with County Ordinance 549. <br /> ------------------------------------------------------------------------------------- <br /> _.X_5....ssv.�-------------- .. ..... <br /> JOB ADDRESS AND LOCATION_-.._____. --------------------------- Phone_eel/65._��.o---q.o...S, <br /> ... ...... .. ... . <br /> Owner's Name-------------------------------------- ................................................. <br /> 11 ........................................................................I................ <br /> Address---------------------------------------;:�C4-z------ ------- ................. Phone----------------------------------- <br /> ---------------- <br /> Contractor's Name--------------------------- ...................... <br /> Commercial 0 Trailer Co u rt C3 Motel 0 Other 0 <br /> Installation will serve: Residence ;4!�_ Apa ent House El Number of baths .- "41.... ...................... <br /> Number of living units: j---- Number of bedrooms,,3--- Num ./--- Lot size ------3 <br /> Water Supply: Public system D4 Community system 0 Private [] Depth to Water Table .145�_ft- <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel [3 Sandy Loam El Clay Loam ❑[] Clay C] Adobe Hardpan 0 <br /> Previous Application Made: (if yes,clate-v-----------------) No fj New Construction Yes [] No FHA/VA: Yes C] Noa <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material------------------------------------------------- <br /> Liquid de pth--------------------------Capacity--. <br /> -------------------- <br /> No. of compartments--------------------------Size-------------------------------- -n Distance to nearest lot line----------------- <br /> Dispos'al Field: Distance from nearest well_________________Distance from founclatio Width of trench_------------------------------- <br /> Number of lines_________________-----------------Length of each line------------------------------- <br /> Type of filter material-------------------------Depth of filter material-----------------------Total length___.___.._....___.__.__..__._.__._.._`._. <br /> /-.Distance to nearest lot line--S71. <br /> Distance to nearest well.....4_�W_15��_Distance from f9unclation.....!��. <br /> -----4 #----- Depth------R5................... <br /> eepage Pit: erial----- Size: Diameter <br /> JU( Number of its---------/----------Lining mat <br /> from foundation-------------------Lining material------------------------------------ <br /> Cesspool: Distance from nearest well-----------------Distance -----------------------Liquid Capacity._......._........_.......-.gals. <br /> ----------Depth----------------------------- <br /> 0 Size: Diameter------_------------------- Distance from nearest building__.____._.__.______.___------------------- <br /> Privy: Distance from nearest well------------------------------------------------- <br /> Distance to nearest lot line---------- --------------------------------------------------------------------- ....................................... <br /> ❑ <br /> ...................... <br /> Remodeling and/or repairing (describe):------------------------------------- ................................................... <br /> -----------------------------------------------------------------------------------------------­­------------------------------------- <br /> -------------------------------------------------------------------------------------- ................................................­­........................................................... <br /> ----------------------------------------------------------------------------------------.............................................................................................................. --------------------- <br /> -------------------­------­---- --------------------�-' -e-d-- <br /> thisappliconand the work will be done in accordance with San Joaquin County <br /> I hereby certify that I have prepared <br /> ordinances State la r les and regulations o the San Joaquin Local Health District. <br /> --------------(Owner and/or Contractor) <br /> ---------------------------------------------------- <br /> (Signed)- ---(rifle)---------- -------------------------_-- --- ----------------- <br /> By:-------------------------- <br /> ---_--------- <br /> ..... --------By:-------------------------------------------------------------------------------------------ell <br /> buildings-,-etc., can be placed on reverse side). <br /> (Plot plan, showing size of lot, location of system in relation to w USE ONLY <br /> FOR DEPARTMENT U <br /> ----------- <br /> C, <br /> DATE----------- /------------- <br /> APPLICATION ACCEPTED BY------ -- -- ---------------- - -------------- ..................... DATE -'--'-'-- <br /> ------------- - <br /> --------------------------- --- - <br /> BUILDING <br /> BY ------------------------------- --- -- ------ ................. DATE------------------------------------------------------ ----- <br /> . ... ........................ .... <br /> ................ ... ..................... <br /> BUILDING PERMIT ISSUED---------------------------------------------------------- - <br /> Alterations and/or recommendations------------------------- <br /> ---_------------ <br /> ---------- . . ............. ................................................ <br /> -------------------------- ........ <br /> ---------------------------------------------- .................. -0--------- ---r------ -- ----- ------------------------------------------------------- <br /> .. ......... ----- --- - ------ - 5 .............I..........................I--------------------------------- <br /> -6- -----------­--------- .................................... <br /> ---------------- ---------- ...... ----------------------------------- -------- .................................... ................. <br /> ---------- ............................................. <br /> ---------- -------- <br /> .................... ------ -------- ----------------*----------- <br /> ------------------- <br /> ------ ------ . ............ <br /> ------------------------------------------ -------------- -------- <br /> FINAL INSPECTION BY: - ---- ----------- ----------------------- Date---J�- -------------------------------------------------------- <br /> DISTRI <br /> SAN JOAQUIN LOCAL HEALTH <br /> 130 South American Street 300 West Oak Street 124 sycamore Street 205 west 9th Street <br /> Tracy,CaliforniaStockton,California Lodi,CaliforniaManteca,California <br /> E9.9 pEVISED B-59 F.P.CD-2M 6-60 <br />