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----------------- -- ----------------------------------- <br /> ------- ........... -------------------------------------- APPLICAT164016R SANITATION PERMIT Permit No. . <br /> - -------------------------:-------------------------- 4 <br /> --- -- <br /> --- --- (Complete in Duplicate) <br /> --- ------------------- This Permit E Date Issued <br /> :,ires I Year From Date Issued ... .........._-_.. .Z-1 <br /> Application is hereby made to the San Joaquin Local Health District for a permit toconstru t" <br /> V�W.1_6t_ <br /> This application is made in compliance with, C nty Ordinance No. 549. install the wolrk herein described. <br /> Iiwq .1 Z:� <br /> L <br /> JOB'vADDR 5 ND LO ATION_.. <br /> Owner's Name____._ . <br /> ...................... ............ <br /> .. ................. -- -------- ------------------------- <br /> ------------------------- ------------------ Phone........................ <br /> Address--.-- -Ad - <br /> ......... <br /> 7 ------- ----------------*------------------------------------*-------------*--------*---------------------------------------- <br /> Contractor s Name._.rn e._. <br /> t, , , ------------------------------_---------_......... ---------------------------------------------------------------- Phone.................. <br /> Insfallaficn,,will serve: Residence Apartment House ❑E]. Commercial El Trailer Court [] Motel 0 Other [I <br /> 4 4- q0 <br /> Number of living units: Number of bedrooms -43--- •Number of baths -4---- Lot size <br /> Water S441y: Public System El Community system C] Private Qj Depth <br /> I! to Water Table k5--- ft. <br /> Character of soil to a.depth of 3 feet: Sand Ej Gravel (-I Sandy Loam k Clay Loam E] Clay [] Adobe 0 Hardpan 0 <br /> - <br /> Previous-Application Made: Of yes,date--------------------) No I)o Now Construction. Yes* No El FHANA: Yes El No [3 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool I permitted if public sewer is available within 200 feet.) <br /> Septic Tank: If <br /> Distance from nearest well__)_#D+.Dista4nce fro f clation-1#1 .4mm <br /> No. of compartments- _&--- �-------- feu .... ------.Material---------- ............................... <br /> size.- <br /> 7 <br /> Disposal Field: ' Distance from near, f .......Liquid depth-----1A------------------Capqcity._j1e#V__. <br /> well-1-04+.-I'Dis,tance from foundation_..# ---------Distance to nearest lot line.&........ <br /> Number of lines_______ ----- -Length of each line---%P Width of trench---4M.�t <br /> -_14----------- --- <br /> -Depth of filter material----- 19--------------Total length-----2di.AJ? ------ <br /> Distance to nearest w ell'-44 ..... ...... <br /> Type' of filter material <br /> Seepage Pit: <br /> ----Distance from foundation....................Distance to nearest lot line_________________ <br /> ❑ Number of pits______________________Lining'-material----------------------Size: Diameter.__.-____.____ Depth------------_------- <br /> Cesspool.: Distance from nearest well------------�_._Distance'from fouriclation..---------0--------Lining material..----------- ------------- <br /> El Size: Diameter_ P ,--.-Depth----------- ----------------------- <br /> - ------- ------ ----------------------------------Liquid Capacity-------------- * I <br /> Privy: Distance from nearest well------k-------------------------------_---------Distance from nearest gals. <br /> C1 Distance to nearest lot line----------- ....... <br /> ----------- -------------------------------------- ------ <br /> Remodeling and/or repairing (describe)__________________' .I---------------- <br /> --------------------------------------------------------------­------------- -- ---------------------------------------------------------------------------------_----_------- <br /> ............... ---------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------•-•----- -1----------I--- ------------------------------------------­----------- --------------------------------------------I- ------ <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed),Olvw-------tw"y --,)i 11-&'v 6 4 e e-----------------------------------------------------------------------------------(Owner and/or Contractor) <br /> By:......................................................- - <br /> !e).-_-------------------------- ------------v--------------------------------(Tif ----------------------------- <br /> (Plot plan, showing size of lot,,location of system'in-relation to wells, buildings, etc., can be plated on 'reZer;;`siQ.-, _ <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED <br /> r- DATE.. ... <br /> pidlo ---------------------------------------------------------------- - <br /> REVIEWED BY --------------------------------- <br /> ----------------------- ------------------------------------------------------------------------------- DATE------- -------------------------- <br /> BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE........----- --------------------------------- <br /> Alterations and/or recommendations:----------- <br /> ------------------------------------------------- ----------I--­----------­---------- .................................I------------------- <br /> ------------------------------------------------------------- ---------- -----------I----------------------------­-_-------------------------------------------------------------------------------------------------- <br /> ..........­--------------------------------------------------------------------------------------I------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------I------- ---------_-------- ---------- <br /> --------------------------------------- --------------------------------- ­------------------------------------------ -------------------------------------------------------- <br /> --------------------------------- <br /> BY-4:::; <br /> FINAL- INSPECTION 13 <br /> ............................ Dafe._.._X --------- <br /> -1---------- -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 730 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California LocR,California Manteca,California Tracy,California <br /> tS 9 REVISED 8-S9 2M 5-61 ATLAS <br />