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1`0,�OFFI�E SV- <br /> - ------- ------- --- <br /> Permit No. <br /> ----------7--------------------------------- A I ATION FOR SANITATION PERMIT ..... <br />--------------------------------------------------------- (Complete in Duplicate) <br /> ------------------------------------------------------- This Permit Expires I Year From Date Issued 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. /Y,�q -s— <br /> JOB ADDRESS AND LOCATON 1.,i., .. Iir/( 4-0171t -I,I a t�� 4 / zxef--;�— <br /> Z............. ......I ...V <br /> . ............ ...................................................... .. ................. <br /> Owner's Name... ------ -- ----------------------------------------------------------------------------------------------------------------- Phone.................................... <br /> < <br /> Address................ 1 .1 ..-y....................................................................................................................................................... <br /> .'!...............�.A. --Z <br /> Contractor's Name.........t-,,,�............3.....TZ......................................................................................... Phone................................... <br /> Installation will serve: Residence ff'-Apartment House [] Commercial 0 Trailer Court [] Motel [] Other 0 <br /> Number of living units: ....f.- Number of bedrooms .-2-. Number of baths J... Lot size ...................... <br /> Water Supply: Public system [�—Community system 171 Private C] Depth to Water Table Xt,ft. <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel [] Sandy Loam E] Clay Loam [] Clay C] Adobe[3-14ardpan 0 <br /> Previous Application Made: (if yes,date-----------------) No e New Construction: Yes []j"No 0 FHA/VA; Yes E] No 21--' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic,Tenk: Distance from nearest Distance from foundation/4. ...........Material..-/�---e............ <br /> ............. <br /> No. of compartments-----2n---------------Size---------- Liquid clep�h... -------------------Capacity.... .. <br /> Disposal Field: Distance from nearest w ll--�—-----Distance from foundation.../&............Distance to nearest lot line... ........... <br /> E5--- Number of lines.............T- ---------- Length of each line-------fLt...............Width of trench....Al..'.................. <br /> Ar-0 <br /> Type of filter material..... .......... <br /> -------Depth of filter material----/Z--- Total length....... ............. ...... <br /> Seepage Pit: Distance to nearest well--'::�---------Distance, from foundation...3�i...........Distave to nearest lot line..��........... <br /> Number of pits.......A------------Lining material....-)k.!-9X.....Size: Diameter.--.'3.--)............Depth..A-�S-../................... <br /> Cesspool Distance from nearest well.................Distance from foundation--------------------Lining material..................................... <br /> 13 Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity............................gals. <br /> Privy: Distance from nearest well----------------------------------------- -------Distance from nearest building.......................................... <br /> 171 Distance to nearest lot line--------------------------------------------------------------------------------............................................................ <br /> Remodeling and/or repairing (describe):........................................................................................................................................................ <br /> .............................................................................................................................................................................................................................. <br /> .............................................................................................................................................................................................................................. <br /> ............................................................................................................................................................................................................................... <br /> I hereby certify that I have prepared this application n tha the work will be done in accordance with San Joaquin County <br /> , e u i <br /> h Joa in <br /> --- -------- <br /> *o <br /> ordinances, State laws, and rules and regulations of the a Joa uin Local ealth District. <br /> (Signed).................................................................. --------- --- -------- ........ ..................................................(Qwner and/or Contractor) <br /> ................. <br /> By:................................................ -------- (ritle)................................................................ <br /> I t. <br /> to 0 wei s. <br /> (Plot plan, showing size Of lot, location of sys4y n relation to wells, 6uildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> d <br /> ..... ............... <br /> APPLICATION ACCEdED BY........:2.-- ----------------------------------- DATE..... <br /> REVIEWEDBY........................................ -------------------------------.............................................. DATE............................................................ <br /> BUILDINGPERMIT ISSUED..................................................................................................... DATE...........................................-................ <br /> Alterations and/or recorrynendations........... ---- ------- ---------.......*0-'Z----------------*----**------------- <br /> ........... ...... <br /> ....................................................................... ---—------------------------------------ ................................................................................................ <br /> ............................................................................. ............................................................................................................................................... <br /> .................................... --------- ............................................................................................................................................................................... <br /> FINAL INSPECTION BY:.......1.,-- . .. .. ------------ Date-----�6- —Am 0 <br /> ----2 <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 8-89 RM 5-61 ATLAS <br />