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APPLICATION FG.. SANITATION PERM4— w Permit No. — <br /> s. <br /> (Complete in Duplicate) <br /> Date Issuedly."It3m <br /> Application is herebya:8e­fo­the-San-Joaquin Loca�.Health District for a permit to construct and install the work herein describe <br /> M <br /> This application is made in compliance with County Ordinance No:549. vo <br /> JOB ADDRESS AN CATIO <br /> ------- ---- --- - <br /> Owner's i ------- ------------------------ <br /> -& <br /> P h------- ------------ <br /> # <br /> on- Pe- <br /> - <br /> i------- ------- - <br /> Address---------------­---- <br /> ----------- ----------------------------------------------------------------- -- <br /> Confracfor's Name-----------------------P�_ �--------------------------------------------------------------------------------------------------- Phone---------------------------------- <br /> Installation will serve:.] Residence � Apartment House E] Commercial E] Trailer Court 0 Motel L] Other E] <br /> I <br /> Number of livir�g unif�:,,_)__-_ Number of bedrooms _27t-.,Nunn size - ------ <br /> 8er 1 of ----? <br /> Water Supply: Public'systern'El—C&-mmun'ify system'h Private Npth to Water TableJ10 ft. <br /> haraicter of soil,to a depth,­6f 3 feet:G Sandy <br /> Gravel L] Sandy' Loam E]--,,Clay Loam E] 'Clay [] Adobe E'j Hardpan E] <br /> Previous'A plicaflon Made: Yes El No New Construction: Yes ` No No <br /> FHA/VA: Yes <br /> P X 1W I N <br /> TYPE OF INSTALLAilON'IAND SPECIFICATIONS:,-, /fi <br /> (No;septic tank <br /> or'cesspool permitted if.public sewer is available within 200 feet.) <br /> i k6i�iio� -e4i <br /> D stance from tin _101-------�.Mater --- ---------- -C <br /> Se tic_Tank: Distance from nearesflwell-- ial- ----------------------- ------ - <br /> No.,of connpartmenfs__.__Zn.............Size---V-,K- ---------Liquid depth__.____------Z/------------------Capacity__,._8_(,T_.r3------- <br /> Disposal Field: Distance from nearest-well-_ Distance from f6y_ncation.A_-1----------Distance to nearest lot ------- <br /> ./------- ---- <br /> ---------------Length o "A69'4---)-S- /- --------------------- <br /> Number of ii4s --- f each line ------5-.Width of trench___ <br /> of filter ma'ferial---Z�. -- ---------Depth of filter maf_,_rlal 19-------------Total length-:6`0--------------------------------- <br /> NL _IV , 1 <br /> Seepage Pit: Distance to,nearesf well----------------------Distance from foun`8ation-----------------..Distance to nearest lot line__________.__-__ <br /> ❑ 'I ifX <br /> Numberl��.'pl its--------------------____Linin material-----------------zfn-Size: Diameter---------- -------------Depth------ ---------------------------- <br /> ' i X.1 <br /> Cesspool: Distance fro"m-nearest well-----------------Distance from foundation------------------- Lining material_______._________________-__________- <br /> X. 1 <br /> Size:,Diameter---z-----------------------------------Depth----------------------------------------------------Liquid Capacify----------------------------gals. <br /> Privy: Distance from nearest well--.---,----------------------------------------____Distance from nearest building________________________.__--_-___-__._. <br /> ❑ Distance to nearest l6f line------------------ ----- ---------------------------------------------------------------------------- <br /> --------------------------------- <br /> Remodeling 3nd/gf-repairing (des x�w� <br /> ---- ------ -- ------- - <br /> 1 -------------- <br /> ----------------------- --------- ---------------- ------------------ ---- <br /> Wat---------- ------ ----- --------- - --------------------------------------------------------- <br /> --------------- I----------------------------------k , . J_ I '� <br /> ---------- ------------------ ------ - ----------------------------------------------I- <br /> ------------------------------ <br /> ------------------------------I------ ------------------------------------------------------------------------r----------------------------------------------------------- ---------------------------------- -------------- <br /> I here6y.6ertify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun+yt", <br /> ordinances..Stat p laws, and rules and reulafions of the San Joaquin 1_6cal Health District.— <br /> ( dA/ -- ----- - - -- -- -- ----- <br /> ------------------------------------------------- . Title)_____________________________________________ - ---------------- <br /> -------- -------------------`(Owner and/or Contractor) <br /> --------------------- -------------------------------------------------- ----------- ( <br /> ---------------- <br /> -----------L............. . <br /> (Plot plan, showing size of ot, location'of system in relation to wells, buildings,-_e can be,placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> - <br /> APPLICATION ACCEPTED By------aqu----------- --------------------------------------- DATE- --- -----------------------------' <br /> REVIEWED ------------------- - DATE- <br /> -------------------- ---- <br /> BUILDING ------- <br /> PERMIT ISSUED.-'.'.'.-. ----------------------------------------------------------------------------- DATE---------------------I---------------------------------------- <br /> Alterations and/or recommend at ions:----------------------------------------------------------------------------------------------------------------*_--------------------------------------------- <br /> ----------------------------------------------------I--------------------------------------------------------------------------------- ------ ---------------------------------------------I__------------------------------ <br /> -------------------------------- -----------------I----------------------1- ------------------ ------------------------------------------------------------------------------------------------------------------------------ <br /> ---------------------------I----------------------------------- ----------------------------------------- ---------------------------- --------------------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------- ------1----------- ---------------------------------------------------------------------------------------------------------------------- <br /> 7SA zNJ7AZQL IN LOCAL HEALTH DISTRICT <br /> FINAL INSPECTION - --------- <br /> BY: -- - ---- -------------- Date__.: t1 T <br /> .__' -------- ---------------- ------------------------------ <br /> 130 South American Street 300 West Oak Street 132 Sycaniore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES_9_2M - Revisea 1.57 F,P-CO. <br />