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FOR OFFICE USE: <br /> --------------------------------------------------------- <br /> APPUCAT'OK"rFOR SANITATION PERMIT Permit No. ......L!�............ <br /> ------------------ ----------- -------------------------- . , C-0 IT <br /> 'z,� (66irl plife in Duplicatel <br /> ------------------------- ------------------------- <br /> ------------------------------------ ---------------- --- This-Pe- Date'Issued ........... ------4 <br /> "Permit Ex 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. 15080 C— <br /> w) <br /> JOB ADDRESS AND, OCATION_'_? _-Cm w------- .o......../V- ----- R1 , <br /> --------------------------------------- <br /> Owner's Name------ -------------------- ----------1-------------------------------------- Phone------------------------------------ <br /> Address_... T F_. Y�-------- <br /> Contractor's Name------ -------------------------------------------------------- .........................------------------------ Phone ..................... <br /> Installation will serve: Residence [-] Apartment House E] Commercial D__`Tlailar Court [_] Motel C] Other <br /> Number of living unit =--- Number of bedrooms Number f baths -3- Lot size .................. <br /> Water Supply: Public sys+e <br /> M si;nmunity_system_gPrivate.- Depth Water Table ft. <br /> Character of soil to a depth of 3 feet: Sand 93"/Gravel D Sandy Loam Depth <br /> Loam [3 Clay D Adobe❑ Hardpan <br /> Previous Application Made: (If yes,date--------------_.___) No jrNew Construction: Yes 0�o E] FHA/VA: Yes E] No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> !f6FMcsran-k­d­r-66s5pd6l 0-ainjiffed if 1ublic sewer is available within 200-feet.)--�.� <br /> 'D, _77 <br /> PNOV01fic Tank: 0/�C—; 1�istance ffromnea -11, Distaice from foundation--------_---------Material-----------------------:�...... <br /> No. of compartm. s_.. --n_t_-------------V 14�------------------------*-._---_Li dep�h--------------------------Capacity___!-------------- <br /> Disposal Field: Distance from nearest well.... J-Ristance from founclatiori_._..f0___.__.-Distance to nearest lo4line.1',------------ <br /> Number of lines----------- I-Le*hgth of each line______ -..Width of trench.....___�& _._t:l <br /> Type of filter filter material----- gth......... ........ ------ <br /> Seepage Pit: Distance to nearest well-------------------[DisfaX from foundation--------------------Distance to -nearest lot line;::..________... <br /> ❑ <br /> Number of pits----------------------Lining'1maferill-----------------------Size: Diameter------------------------Depth----------------------------------- <br /> Cesspool: Distance from nearest well----------A _.Distalle foundation_____________ ____ Lining material__.--...-______________-_-.---__-____ <br /> El Size: Diameter------------ ------------------------it!---Depf h---A ---------------------Liquid Capacity-------•--------------------gals. <br /> L41. ,�G----------------------- t <br /> Privy: Distance from nearest well_____________ ------------- Distance from nearest buif'di'n'g--------------------- -------------------- <br /> 171 Distance to nearest ]of line------------- <br /> Remodeling and/or repairing (describe):------------------ - <br /> - ------------------- <br /> - <br /> -- -----0--------------------------------------___----------------_------------------------------ <br /> -------------------- - - 111 --- <br /> .............I-------------------------------------------------------------------------- ----------------------------V-!114------------------------_------------------------------------------------------------------- <br /> -------------------I---------------------------------------------------------- ---------­--------------­----------- 01 <br /> ----------------------------------------------------------------------------------------I------ --- <br /> ---------------------------------------------------------I-------------------------------- ----------I-------------------------------------------------------------------------------­------------------------------- <br /> I hereby certify that I have prepared this a - lication and that the work will be done in accordance with San Joaquin County <br /> ordinances, Sfaje laws, and rut and regula ' ns,o San Joaquin Local Health District. <br /> ed In' a licatiom <br /> 5g) <br /> u s, <br /> Sfa laws, and rul and lal n <br /> ..77 <br /> ---------- ----------- -------- <br /> (Signed)------- ------- --------- - -------------------------------------------------------------------(Owner and/or Contractor) <br /> - ------- <br /> -------- ---- <br /> -------------------*--------------------------------- ---- ------------------------------ ----- ... <br /> . ........ ... .. <br /> M <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be f�Iicedon-,rev4se side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------ ------------------------------------------------------------------ DATE-------- <br /> REVIEWED <br /> ATE---------REVIEWED BY--------------------------------------------- ----- -------------------------------------------------------------------------- DATE----------------- <br /> BUILDING <br /> ATE-----------------BUILDING PERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE------------------------------ <br /> Alterations and/or recommendations:----------------------------------------------------------------..------------------------------------ <br /> --------------------------------------------------------------------------------------- ------------ ---------------------------------------------------------------------------------------------------­------------ <br /> ------------------------------------------------------------ ------I--------------------------------------------------------------------------------------------------------------------------------------------- <br /> -- ---- -------------------------------- <br /> ------------- <br /> -------------- ----------------------------- ------ <br /> ................. ---------------- --- -- --------- A <br /> --------------- 0 <br /> --------------- ------- ..... ...... ----------- ---- ---- - - ------ --------------------------------------------------------------------I-------------------------------- <br /> -------- Date-- --------------------------- ------- <br /> FINAL INSPECTION BY . . 7 <br /> ---------- <br /> SANI JOA(?UIN LOCAL 'HEALTH DISTRICT <br /> 130 South American Street 300 Wool Oak Sireet 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED B.59 2M 5.62 ATLAS <br /> 1 <br /> I s4 <br />