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FOR OFFICE USE: <br />--- ------- --------- ---- ------------------------------ APPLICATION FOR SANITATION PERMITPermit No. _9 <br />--------------------------------------------------------- <br /> -------- <br /> --------------------- (Complete in Duplicate) Date Issued P.----/y"40 - <br /> --- This Permit Expires 1 Year From Date issued '01,7-050—0 <br /> ( <br />----- ------PPlicat <br /> ------- e6---------------------- construct and install the work herein described, <br /> T 1; <br /> ,6, ion is hereby made to the San Joaquin Local Health District for a permit to <br /> with County Ordinance No. 549. <br /> app <br /> icationis,madein- i compl'a ce <br /> 77 sir:-.""-."""-""". <br /> JOB ADDRESS AND LOCATION <br /> ----- <br /> Phone------------------------------------ <br /> --------------------------- - <br /> 4.,rw2---------------------- --------- ------------------ <br /> Owner's Name------ <br /> > ...... <br /> --------------------- ---------------------------------------- <br /> ------ - ---------t----- <br /> Phone------_-------------------------- <br /> ------------ <br /> Address--------jx*.2 ---------------- <br /> Contractor's Name------- ---:a�__� ---- ---- ------- Motel E] Other 0 <br /> Installation will serve: Residence [A Apartment HouseE] Commercial F] Trailer,lCourt [I <br /> Number of living units: J--- Number of bedrooms Number�Of--bat�s--,/:!.--4,,LLot size .-&a------- —------------ ------ <br /> Community system El Private Depth to Wat6r Table ----- ft. <br /> --- <br /> Water Supply: Public system 0 K [Clay LoI III <br /> Character of soil to a depth of 3 feet: Sand F1 Gravel [] Sandy Loam am [I Clay C] Adobe El Hardpan C] <br /> Previous Application Made: (if yes,date -_----------------) No E-] New Construction i Yes El No E] FHA/VA: Yes El ,No <br /> ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic lank or cesspool permitted if public sewer is available within 200 fe6t.) <br /> Septic Tank: Distance from nearest well -from foundation-------------------Material-------------------------------------------------- <br /> ---------- =Dis+ance <br /> V11 <br /> No. of compartments------------ ------------Size----------------------------- ---Liquicl�clepth--------------------- .___Capacity--------------- <br /> El <br /> nearest wej ----Distanc�'from foundafion__Zb!--""_----Distance to nearest lot line___.!�_ <br /> - Distance from n, Width of trench---X------------- -------/ <br /> ------ <br /> Disposp�'Fielcl. I ---- ---,,j <br /> Number of lines------------- -------Length of each lirie__�10_0- ------------- <br /> teriai------Sj.R�1-7C) fh7of filter material---14............Total length----_--!__!3.O-------------------------- <br /> Type of filter ma - .. ep 0 -founaation-----I--------------Distance to nearest lot line-_" ---------- <br /> Seepage Pit: Distance to nearest well----------------------Distan�e-frc;—m: - -w- ­ <br /> ze-.-D;arnefer__.---------------------Depth--- -------------------------- <br /> Number of pits----------------------Lining material-------------------7Si <br /> ❑ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation----- -------------rLining material---.--_----------------------_-.-._ <br /> r_1 Size; Diameter-------- -------------------- -------Depth-------------------------------------- ---------- Liquid Capacity-----------------------------gals. <br /> Privy: Distance from nearest well""---------------------------------------- -----Distance from nearest building----.-.-----"-------"---------------------- <br /> ----------------------------------------------------------------------------- <br /> 0 Distance to nearest lot line-- ---- ---- --- ----------------- ---------------------------I <br /> *1 1 <br /> -----•--- ----------------••---------------------------------. <br /> Remocleling and/or repairing (describe)----------------"" <br /> ------ ----- <br /> -- ---------------- ------------------------------------------------------------------------------- <br /> ------------- ------- --------------- ---------------------*---------------------------------------------------------------------------------- ----------------------------------- <br /> --------------------------------------------------- <br /> -- <br /> --------------------------------- ----------------------------------------------------------------------------------------------------------:1�----------------------------- ----------------------- ---------------------- <br /> I hereby certify that I have Prepared this application and that the work will be-I'done in accordance with San Joaquin County <br /> ordinances,LStalaws, and rules and regulations of the San Joaquin Local Health District. <br /> d I <br /> .- and/or Contractor} <br /> (Signed)----- ----------------- --------- <br /> .e - (4-- ____ ---------- .... .... ............ ... ------- .. ....------------ <br /> ---- ---------------------- ------------------------- <br /> By:_ --- ------------ <br /> (Plot plan, showing size of lot, location of sys m in relation to wells, buildings, etc.,'can be placed an reverse side). <br /> - <br /> DEPARTMENT USE ONLY 1S <br /> APPLICATION ACCEPTED BY------------------ .------ -------- <br /> ------- DATE------- <br /> - ----- <br /> - <br /> ------------ ---------------- <br /> - <br /> ------- DATE---- ----------------------------------------------------- <br /> REVIEWED BY-------------------------------- --------- --- - ----- --....----------------------- <br /> --------- <br /> 0 <br /> ----- DATE <br /> BUILDING PERMIT ISSUED ----- - --_ - -i <br /> Alterations and/or recommendations:-------------------------- - -------------------------------------- <br /> ------------------------------------------------------------ <br /> --------------------------------------- <br /> --------------------------------I------------------------------------------ -------- -------- --------------------------------!1 <br /> -----------------------------------------------------------------------------------------------------------------------------­------------------------------------------------- -------I---------------------------------------------------- ------------------------------------------------�------------------------------------------ <br /> ------- - ------------ ------------------------------------------------------------------------------------------------------------ <br /> ------------ - -I-------I---------------------- --- <br /> = ----------------- <br /> - - ------------------------------------- <br /> _ <br /> FINAL INSPECTION BY:.------ --P_ Dat) -----� -- 17436... . -------------------------- <br /> �--------- <br /> SAN------------------------------ <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> :7 <br /> Stockton,California Lodi,California Manteca,Cc:hfornia Tracy,California <br />