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FOR OFFICE USE: <br /> w 41 <br /> ----------V--------------------=------------------------ <br /> ________________________________________________________ APPLICATION FOR SANITATION PERMIT Permit No. _1_ ---a./.. <br /> - --------------- ---------------:----------------------- (Complete in Duplicate) 7 <br /> ` -:. :_. : . a... „Date Issued ��, <br /> ------------------------------_._.__-:________._____.___. - This Permit-Expires'1 Year From Date Issued" " " <br /> a� <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work here n described. <br /> This application is rndclefin compliance with County Ordinance-No. 549.- <br /> S �� <br /> ,-.��w`-�. ',, <br /> JOB ADDRESS AND LOCAT ON___-- -------=--t-`- -- -- <br /> Owner's Name -------- -.. __ . - ---------- ------ Phone.- <br /> 30 <br /> Address i <br /> g _ _Ire <br /> : ,re� <br /> ----------------------------------------- ----------------------------------------------- <br /> 0­11 <br /> -----• ---------------------- <br /> e. ..-----• ----- ---------- <br /> Contractor's Name--------- �, elm--- <br /> Phon <br /> Installation will serve: Residence 'Apartment House Commercial Trailer Court ' Mot'slY Other <br /> Number of living units: ._ ._.. Number of bedrooms ___ � umberTof baa hs ___ Lot size r <br /> Nom'` / - _ <br /> Water Supply: Public system Com unity systemPrivate E] Depth to Water Table <br /> r r <br /> Character of soil to a depth of 3 feet: Sand Gravel [) Sandy Loam ❑ Clay Loam p--CJay ❑ Adobe❑ Hardpa`n 0 <br /> Previous Application Made: (lf yes,date---------------------) No 14 New Construction: Yes } No ❑ FHA/VA: Yes ❑/ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: Af. <br /> {No septic tank or cesspool permitted if.public is available within 200 feet.) } i i <br /> Septic Tankr Dunce:from_Hearse+ veE i�lj1']"Di once=from fo`u' nn a+ion_�Q' Material!*_____ c <br /> r�--- r <br /> No. of compartments______-- -- __-.: �.:-Size'.--�'�2 _�___ gs-._--Liquid depth----/ ----- -- --- Capacity 6�_� --1'f ' <br /> y . G r'7v- ` f''a9.O x`: <br /> Disposal Field:" Distance from nearest wX—'F—&'_Distance from found6on---1-0} ________-D��i'�stAce .te nearest lot line_____IS.. __ z <br /> Type of filter mater Depthoffilter mlater�i ���_.1Ni+dth of�trench--_,rZ y f ----------- <br /> T <br /> --------• E <br /> Number of lines__ . 14 <br /> Tti� ' <br /> : tel length___.__ -Z•74� <br /> Seepage Pit: Distance to nearest well--- --------------Distance from foundation-------------._._=!Distance to nearest lot line----------I---- <br /> J <br /> ❑❑ tDiameter _ _____________Lining mateNumber of pits-_____ rial______ � -(-_Sfize: Diamet'er <br /> ----�-----_------ -.----..Depth-:--__----•_-_-_-_-n_--=-ti---- <br /> -----r---�'- <br /> - <br /> Cesspool: Distance from nearest well_________________Distance fromfoundation------------- material-----•'•---=-----=F------------- <br /> Size: <br /> --•- ------- <br /> Size: -_-_--.-- -- - -------------------De th-------_--}�-- ------ -------------------------------Liquid Capacity- _______..__gals <br /> . <br /> Priv Distance.from nearest well.------ -----------AA from nearest building * } <br /> Y� � � .,,,.,.-...:.moi.. ----------- ---- ------------------ <br /> ❑ ---------- ----------------- <br /> - - t% -i <br /> Distance-to-nearest�lot*line__,.��w.,=_'-_`-"--- -----_-°-----f-•= -�-�;;- -----��--•-•- -----------•------•-------- --�-- <br /> Remodeling and/or repairing [describe):-______ _ _`.tP_Z-.___.__1�1_©-i__._._ i_ �. . <br /> - '=G�- ----- <br /> -------------------------------•-------------------------------------------- i F t =^ <br /> _v � <br /> -------------------- <br /> ----------------------_-----------_--------------------------_______________ __ 1____.____:-_—__._____ c......_ _____ \. <br /> ------------------------ ---------- ----------------------------------- <br /> ! hereby certify that I have prepared this applicatio^'and that the work will W done in,accord c^e eg w'ith--San Joaquin County <br /> ordinances, State , and rules and regulations otihe-Sart Joaquin Local Health District. <br /> (Signed)..-_:. - <br /> - .-__ caner an ontract <br /> __O and/or orI <br /> 13 i <br /> Y� = --------------- -------- t-- -------'-------------------------------(Title)---------------------- <br /> (Plot plan, showing size of lot, location of system in relationao wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE 0Nly."' <br /> 5 <br /> APPLICATION ACCEPTED BY - ��r..- �`-�+ - DATF17-55-��F --------------- ----=----- <br /> REVIEWEDBY. - ----------------------------- -- ----------------------------•--------•--- DATE-,- --_::--._:.:.:_- :=.�`-_::----------------------- <br /> BUILDING PERMIT ISSUED------------------ i ........--------•_•--------------------------------------- DATE-------•----- ------------------------- <br /> w <br /> -- <br /> Alterations-and/or recommendations_____________________________-,_ 'LL _ -_------- <br /> --- -'--- - ••- <br /> -- -- -- �- - { <br /> P. <br /> 5 D <br /> -- <br /> -- --- --- ------------------- ------------- <br /> -------------------------------- ---- <br /> _ D � <br /> TF <br /> FINAL INSPECTION BY:------ - -•- ----"----- -------=---------------- -Date i <br /> SAN 30 QUIN LOCAL HEALTH STRICT <br /> 130 South American Street ,\390 Wast OalStreet T� �. Di 24 Sycamore Street 205 Wast 9th Sfet_ <br /> 1,Stocktonr CallfO Aia ; �+S }yfij�'Lbdl;Galifornlp Manteca,California <br /> t y; s ti Tracy,California <br /> �,a., <br /> �B-9.REVIBEO 0-59 r.P.CO.IIM 6.60 <br /> VVV �� <br />