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F0k'0FFICE USE: <br /> -_0----------- dc-7 <br /> APPLICATION FOR SANITATION PERMIT Permit No.. ........................ <br /> ...................... <br /> -- -------------- -----------------­-_­--------- <br />------------ -------------- -- -------------------------- (Complete in Duplicate) Date Issued <br /> -------- ----------------- ------- -This PFrm—irEiOiFes�1-Y6a—rFFom—D-9"e _SSGe_d` <br />------------ -- --- 11 11, <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 r(Eirdinance-No-.-549.- <br /> ------------------- ------------------------------------------------------------ <br /> JOB ADDRESS AND LOCATION...__3 ---------S-....... <br /> Owner's Name--------K <br /> 9-v........ - - - - ... Phone------------------------------------ <br /> Address-...... -- -- - --------- ------------------ -------------------------------.--------------- ----------------------- <br /> Contractor's Name----- - --------­------ --­------------------ -------- ------------------------------------------ -------------------- Phone----------------------------------- <br /> Installation will serve: Residence [A Apartment-House El Commercial El Trailer Court El Motel El Other El <br /> Number of living units: ___1_._ Number of bedhoomL......Number-of-baths'71�_ Lot�size __,5T_)_t----x----Water Supply: Public system [& Community system [] Priva.ten Depth to-Wafer Table _�_O_ ft. <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel [] Sandy Loam El Clay Loam [_1 Clay 0 Adobe IM Hardpan (I <br /> Previous Application Made: (if yes,date--------------------) No Dq New Construction: Yes Dg No [] FHA/VA: Yes El No 0 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: . <br /> (No septic tank or cesspool permitted if public sewer is available within'200 feet.) <br /> Septic Tank: Distance from nearest well---K OACE-Distance from foundatio-W114,-C)E-------.Mixte riaI__'C.6A_.W---0_0 J--------------- <br /> - - -A -o - - I depth-- --2------------------- A-Q-0--------- <br /> 7�e '.T 7T <br /> No. of compartments--___---. -------- Capac;fy <br /> Disposal Field: Distance from nearest well..W6.q.-G-Distance from foundation---J-C----------Distance to nearest lot line----------------- <br /> -- <br /> 59 Number of lines-_---5----------- --------:----Length of each line-------Y,6---------------- <br /> Width of french_____7Z4---1.1--------------- <br /> Type of filter material-!SI)-----T.6--rk-Depth-of-filter-materialL------I <br /> --------Total length------1 __O--- <br /> --------------------- <br /> fforri,flounda-fion----10-1--------Distane cto nearest lot life.__ _r- <br /> Number <br /> 1 <br /> Seepage Pit: Distance to nearest.well-- Distance - - I I <br /> Diameterr-A'-AA6-------Depth---------b. .................. <br /> Number of pits______Z----------I-U.rilng materialsF -,.Size: <br /> Cesspool: Distance from nearest well________________Distance from foundation_____._._._._____-- Lining material____.._________----.__.___.__-______ U) <br /> ---Liquid Capacity-. -------------------------gals. d <br /> El Size: Diameter_---------------- ---- -=e p t�--------------------------------- --------------- 1 <br /> Privy: Distance from nearest well___._____.__----- ---------_--.-------------..-Distance from nearest building.___________________________._---------. { <br /> ❑ Distance <br /> uilding---------- -- ------------------- - ------ <br /> Distanceto nearest lot lire----------------- --------------------- ----- ----------------------------------------------------------------------------------- ------------ <br /> ------------------1_----------------------------------------------------- <br /> Remodeling and/or repairing (describe):----- -- ------------- --------------- <br /> - ------------------I------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -- - <br /> I I <br /> -------------------------- <br /> ------------------------------------------------------------------------------------------I-----------------------------------------------------I----------------------- ----------------------- ---- <br /> - ----------------------------------- ----------------------------- ------------------------------------------------- ------------------------------------:---- ----------------------------------------------- ------ ---- <br /> I hereby certify that I have prepared this application an ­f1fawth-e--vioukwill be done in accordance with San Joaquin County-? <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> • <br /> [Signed} kv-- - - ------- --------- ------------------ ---------------- -- <br /> ------------ --- ---(Owner and/or Contractorl <br /> 41;: -- wof�_ _ -- - ------ ------(Title)---------------------- ----------------------------------- <br /> ------------------------ ----- -------------------------------------- ---- ---- ------------------ <br /> (plot plan, showing size of lot, location of system in relation to w.ells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> ----------------------------- <br /> APPLICATION ACCEPTED BY- ¢ -------------------------------------------------------- DATE-..t\----7 <br /> ,3tD.-i- <br /> ---------------- DATE------------------------------------------------------------ <br /> REVIEWED BY-------------------------- --------------------------------- ------------- ------------------------------------------ DATE" <br /> -------------------------- ----------------- --------- <br /> BUILDINGPERMIT ISSUED--------------------------------------- ---e------------------- <br /> -----------L ------- ------ <br /> Alterations and/or recornmenclations___11 <br /> ------------------------------------------------------------------ ---------- -------­- ------------------------------------- ------------------------------I------------------------------- <br /> ----------L-------------- --------------------------------­­-------------I---------------- ------------------------------- ------------------ ------------------------------------------------------------------ --------- <br /> ---------------------------------------------­------ ------------- ---------------------------- ------- ------------------------------ - -------------- ------------------------------ -------------------------------------- <br /> ..................... ---------------- ­­------------- --------------------------------- - --------------- ---------------- --------------- ----------------------------------------------------- - --------------------- <br /> FINAL INSPECTION BY:--- ........ --------- -------------------- --------------- <br /> jbt��. _ ------------- <br /> 10 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street .2 1:�_, ; i,124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California may. Manteca,California Tracy,California <br /> Ala""I r*L/e..L- 115�-10 4 <br />