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FOR OFFICE USE: 1 <br />--------------------- <br /> ------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. _..7.... ........... <br /> - z <br />--------------------- <br /> (Complete-in'Duplicate) Date Issued <br /> __-___-___._"____.-__-_-____.. This PermitAkpires '1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit tc'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 /> ��•,�/J� � ---------- - ---------- ---- ----------- -------- ---------------------r� <br /> - ---- --------- <br /> Owner's Name----- " . lel --------- - -------- Phone "L ------- <br /> ------------ <br /> Address__ <br /> _ l.t. - / y x�. . Vit- '" s-r-��� Cd TvF-�------ --------- u��j <br /> p ---------- Phone.,L�..4Y-4 ...... <br /> Contractor's Name0s40A1C___e-0_-tC-"��l <br /> Installation will serve: Residence it Apartment House ❑ Co.mmercial-❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _L... Number of bedrooms ------ Number of baths------'^Lot size ----- --- -------- ----------------------_.-__---_.-__- <br /> Water Supply: Public system ❑ Community system'❑ - Private M Depth to Water Table ` _ ft <br /> _ r <br /> Character of soil to a depth of 3 feet- Sand E] -Gravel ❑ [S- Sandy Loam, Cay Loam ❑ Clay E] Adobe E] Hardpan E] <br /> 01 s I <br /> Previous Application Made: (If yes,date----------- " -- ) No ❑ New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: - .�-•-« -----*---- """'�'"+""� ,_ <br /> .� <br /> (No septic tank or cesspool"permitted if publics sewer is available within 200 feet. <br /> Septic Tank: Distance from nearest well--- - ..Distance from foundation---te-----------.Material 9 ---- .... <br /> No. of compartments . Size G _Li Liquid de th-_-_--- Ca acit 1�_d � <br /> P 4 �� q P Y <br /> Disp sal Field: Distance from nearest wellI-----.-Dista a from foundation A . -....Distance to nearest lot line/Pb..._.... <br /> Number of lines... LengtK jof each�me__-_7,_ `'��.. ...Width of trench.*-`� --=�"� <br /> De th.:of filter. material Total length..J-.�0-- .. _...... <br /> Type of filter material.. 1.- P ti <br /> Seepage Pit: Distance to nearest well_��0..__._Distance from foundation... ---.-...Distance to nearest lot line.,.? ._--- 0 <br /> -r _. <br /> Number of pits--- -----------...-----Lining material- ----------- ------ Size: Diameter Depth - = <br /> ti Cesspool: Distance from nearest well ________________Distance from foundation------- -.Lining material.-............j._�`_,v--._------ <br /> ❑ Size: Diameter- ----- ----- --------- ......Depth_t-------------------------------------- --------.-Liquid Capacity-------------- ------ •gals., <br />' l _-__Distance from nearest building. <br /> Privy: Distance from nearest well -----------=-----•----- - <br /> ❑ Distance to nearest lot line--__--.--_----- ---- -- <br /> -C_(,�..11�f-�'l'/r-K�F4� ---------------`-•- ----•-----•----- .------------------------------------------------- <br /> Remodeling V' <br /> and/or repairing (describe):-..'Al -.-. _ - - <br /> 1 1 ...� ; ------------------------------ - .-..---------- �----------- ----. <br /> r <br /> ---..- .._-.._.--------'---.....-------------------- - ----w.-.e-..._..._.._.-._---_.._.`,... ---- --_- <br /> _---- ... ............ __----------- _--- ---' It - ._._-...__ __._.-_-.. ..-._-__-_-_ -_._.. ._----------------_. .. <br /> ----- -- - --.-. -- ------------- - - <br /> °'-' . t --- - ----- ---- - -- <br /> I hereby certify that I have prepared this application,and-that-the•work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed) .. __ _f .c©-Iq <br /> �; -' •x-t- $ ` = -- (Owner and/or Contractor) <br /> BY� 6 ---- -- --------.. . _ - ---•- Ft e ----------- - --- --------- <br /> (Plot plan, showing size of lot,.location of system relation to wells, buildings, etc., can be placed oih reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> ACCEPTED BY---------- ms-- µ -------------------- ------ DATE{. -• � -- ------------------- <br /> APPLICATION <br /> REVIEWEDBY----------------------_------- - - --------------------,-- -- ----------- DATE----------------------------' - ----- ----------------- <br /> DAT <br /> --------- - <br /> ' BUILDING PERMIT ISSUED..----- -------. DA — <br /> - TE <br /> and/or recommendations: ! '` _ 7 '`'s' `5 -- - X �F � ------- <br /> V- <br /> AlterationsY <br /> I -_------------------------ --------------------__ — - - _19�.-✓ `/ '"°� '' ` <br /> ---------•---------------------- --------------------------------- ------- <br /> ---- - <br /> . .Cv� ...�,. ------ <br /> -- - <br /> - <br /> - c — <br /> ----------- - <br /> -7- <br /> Date FINAL INSPECTION BY:.--------- ----- --------�. <br /> .� - <br /> - -­------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> t <br /> 1601 E.Nazelfon Ave. 300 West Oak Street �ar,f 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi. California Manteca,California Tracy,California <br /> M <br /> E.H.9 2M 147 Vanguard Press <br /> s <br />