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FOR OFFIC USE V R /-2 0 <br /> �y <br /> - ----- ---�_ APPLICATION FOR SANITATION PERMIT Permit No. <br />--------------------------------------------------------- <br />--------------------------------------------------------- (Complete in Duplicate) <br /> r-----I-------- it Expires I Year From Date Issued Date Issued --- <br />------------------ - - --- --- ------------------- !This Perm <br /> Application is hereby made to the Sari Joaquin Local Health District for a permit to construct and instali the work herein described. <br /> This application is made in compliancei with County Ordinance N <br /> JOB ADDRESS AND LOCATION-- - --- - --- --- -------------- .......... --- ----------------------------------------------------------------- <br /> Owner's Name-••--- ---- ------------- °.. ._------- - ------A"n" ---------------- Phon,a....___--------------------_---- <br /> f <br /> Address----- 2 e........ • ------------------ ------------------------------------ -------- ----------------­-------I----------------------------------------- <br /> -------------------------------------......... ------ <br /> Contractor's Name.. ----- T------w------ Phone----------------------------- <br /> ---------------------­:. <br /> 0❑ Commercial E] Trailer Court E] Motel ❑ Other [I <br /> Installation will serve: Residenco..[!��Apartment House <br /> I <br /> Number of living units::4____ Number of bedrooms' _J. Number of baths-.A _ Lot size ----- ------------------------------- <br /> Water Supply: Public`system El Community system El Private 0��Depih'to Water Table _4_�Pft. <br /> Character of soil to a depth of 3 feet: Sand Ej. Gravel E] Sandy Loom [I Clay Loam 0 Clay ❑ Adobe 0-11pardipan C] <br /> Previous Application Made: (If yes,date________..___.__--) No New Construction: Yes �El FHA/VA: Yes D No llf" <br /> TYPE 'OF INSTALLATION AND SPECIFICATIONS: <br /> '(No septic tank.or cesspool permitted if,public sew' er is available Within 200 feet.) <br /> If i 14-1 .� I f <br /> Septic T nk-.-; Distance from nearest w;11_,L0--------Distance from foundafion-/-O------------- --------- <br /> I yw <br /> No. of compartments-------2-------- - ------ <br /> Size..._....3___ dep,th------- ------ Capacity_ §Af <br /> Disposal,Eeld: Distance from' nearest well-iSV-------- from f'ounclation 1_4?!��_Distance to nearest lot line.*------------- <br /> -f l . <br /> Number of lines___:__------'------- <br /> 2----------------Length of each line_____:__74-----------------Width of trench------A-k---e------ <br /> Type of ------- <br /> Typfiler ----- epof marial----Y-1........... Total length-------ILI -__1------------------­_ I <br /> t <br /> ... ...- -*-I- .. -- - ---Depth filter te <br /> - I i _ — ...? " 1� <br /> Seepage Pit: Distance to nearest ___._____Distance from fo-rundation--- Distance to nearest lot line.65........ <br /> Number of pifs�----� ------Lining material-.--- Size.: biametet---j-3--------'--..Depth-------,2 -------------- <br /> Cesspbol: Distance from nearest weil-----------.--'--,Distance from foundation---------------------Lining material__._____________.________-_-______-_. <br /> i, <br /> [] Size: <br /> aterial------------------------------------- <br /> Size: Diameter------i___1-----------------------------Depth------------------------------------------------------Liquid Capacity--------------•-------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ <br /> ❑ Distance to nearest lot line._-______._____--------' ------------------ ------------------------------------ --------- <br /> Remodeling and/or repairing(describe):- 7--------------------------------------- 1....... ----- -­-----------I—--------------------------------------- <br /> ----------7------------------------------------------------------------------------------------- 7--------------------------------------------------------------k <br /> --------------------------------------- ------------------- - --------­------------ <br /> -- <br /> -------------------------------------------------------------- <br /> ----------------- -------------------------------------- ---__-.-___.-..------••---------------------------`------------ <br /> - <br /> I hereby certify-that I have prepared fhis'applicafio�n-and-f hat the work will be done in accordance with San Joaquin County <br /> ordinances, State laws,'.and.rules and reguIafio79Dyfthe,San Joaquin Local Health District. <br /> (Signed)--------"-------------- -----------...(Owner and/or Contractor) <br /> ------ ------------------ <br /> ---- -------- -r----------------------------------------------------------- -----$ <br /> By:-----------------------L - ----- ---------I---------------------------------------- -----(Title)-------------------- -----------­­-------- ---------- <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__� <br /> -------------------- DATE-- --------------------- <br /> - ---------- -------------------------- DATE---------7---------------- .......................... <br /> --- -- ----- <br /> REVIEWED BY------------- --------------- ----­------------------- -------- <br /> BUILDINGPERMIT ISSUED--.--.-Z,,/--'- ------------------------------------ ------------------------------------------------ DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:. <br /> -------------- ------------_'_.______....___.__-___=________ -------------------------------------------------------------------- <br /> ------------ e-- ---------------------­ ------- ---------------I-------------------------------------------------------------I--------------------------------------------------------I------- <br /> - ---------------------------------------------------------------------------------- ..........I-------------------------------------- <br /> --- ---- --------- <br /> ------------------------ ------- - <br /> ----------------------------------------------------------------=----- ---•-•--- ------------------------------------------------------------ <br /> ----------------- -------------- -- ------------------------------------------------------ ---------------------------------------------------------------------- ------------------------------------------- <br /> Date <br /> FINAL INSPECTION BY:----' ---------------- - --------------------------------------------- <br /> SAN JOAQ:UIN 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 /> EB-9 REVIBEO$-SO F-P-V13-'MM_6_'60 <br />