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FOR OFFICE USE. <br /> ------------- -------------------- <br /> -- -------------- Permit Na .-./------------------ <br /> APPLICATION FOR SANITATION PERMIT <br />-------------------------------------------------------- (Complete in Duplicate) Date Issued ----- -- <br /> This Permit Expires I Year From Date Issued <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 wit County Ordinance No., 49. C9C —0Z4 <br /> 2-5--A)`-(-U ,'i?�:. ........... <br /> Z -----------­----i�i... .. -------- ------------------ <br /> 'JOB ADDRESS AND LOCATION ----- ----------- <br /> -------_--------------- ------ <br /> lop, <br /> Owner's Name------ ............ -- -- --- - --------------------------- ............ hone.... <br /> --- --- ........... .......................... <br /> -------------_ <br /> ---------------_--- <br /> Address......... -------vl.-� P one........------------------------- <br /> Contractor's Name-----------------------------............. -•----------••------------ ---------------------------------- <br /> ❑ <br /> Installation will serve: Residence Apartment House [I -Commercial 0 Trailer Court ❑ Motel [3 Other <br /> Number of living units: Number of bedrooms ---?.. Number of baths .1......Lot size <br /> Water Supply: Public SYstem 13 Community syst( A [] ..................... <br /> Private ❑ Depth to Water Table ---------If. <br /> ' Sandy Loam 0 Clay Loam ET Clay 0 Adobe C3 _ Hardpan 0 <br /> Character of soil to a depth of 3 feet: Sand E] Gravel 171 <br /> .1 --------) No New Construction: Yes 0_ N6 L] FHA/VA: Yes 0 -No [I <br /> Previous Application Made: (If yes,dote----- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> ilable within 200 feet.) <br /> (No septic tank or'cesspool permitted if public sewer is av r a <br /> ------------------------- <br /> Septic Tank: Distance from nearest well-..--------------Distance from foundation----------------_--Material-------_--------------4 ,"�­ .. 11. <br /> Liquid depth--... CaPOcitY---------­- <br /> 0 No. of compartments--------------------------Size------------I------------- ........... <br /> Disposal Field: Distance from nearest well---------------- Distance from foundation------_------------Distance to nearest lot line...,___.-..._.... <br /> El Number of lines-----------------------------------Length of each line----.-------------------------Width of trench----------------------------------- <br /> Type of filter material...... ---------------Depth of filter material-----------------------Total length----- .....-__.__-••-••.................. <br /> P a # .. le j <br /> ................. <br /> o nearest.s nw-w-low from f nclation-----1.0----_.-.Distance to nearest.lot line <br /> Seepage Pit: Distance t f 11 _---.Distance fr -Size: Diameter-_,5_3---------Depth--*.-- ... .............Number of pits-------- material- - .. I <br /> Cesspool: Distance from nearest well-----------------Distance from foundation.-------------•-----Lining <br /> oundation--- ----------------Lining material----------------------------------- <br /> ---------------------Liquid Capacity--------------­------------gals- <br /> Size: Diameter--------------------------------------Depth--------------------------- <br /> Privy: Distance from riearest, well-------------------------------------------------Distance from nearest buildin9----------------------------------------- <br /> ❑ -----Distance to nearest lot line------------------------------------------------------------------------------------------ ----------------------------- ..00 <br /> ----------- <br /> repairing (describe):------------------ 1 .7 <br /> --------------------------- ----------------------- ---- -------- -------------- <br /> ------------------------------------------------------------------------*------------------------------------------------ <br /> --------------------------------------------- <br /> - <br /> ---••-•---•-----------------I------------­--------------- ...........•----- <br /> - ------------------------------------------------------------- --------------------------•-------------------- <br /> ----------­--------_------------------­---------------•------------------------------------------------ ordance with San Joaquin County <br /> I hereby certify that I have prepared this application and that the work will be done in ace <br /> d I t*- of the San Joaquin Local Health District. <br /> ordinances, State laws, and rules an regu a iops <br /> {Owner and/or Contractor) <br /> -------------------------_(own <br /> (Signec%" - ------I—---- --- - - ------------------------------------------- <br /> ---- -- ---- - ----`{Title) -,.:- �- -• <br /> �o <br /> n showin size of lot, location of system in relation <br /> --- <br /> ;on wells, buildings, etc., can be placed on reverse side). <br /> (Plot plan. showing size of lot, location of system in re at <br /> FOR DEPARTMENT USE ONLY <br /> ------------- ------------------------------- <br /> APPLICATION ACCEPTED BY... ---------------------------------------------- <br /> REVIEWEDBY------_----------------- ----------- --------------------------------­"---------•--------------------------- DATE----------------------------------- ------------_--------- <br /> BUILDING PERMIT ISSUED------------------ ------------------------------------I.........----------------­----------­-------- DATE_-------------------------- -,--,-*.I-_.-----,--.-.-.---m------.-------. <br /> Alterations and/or recommendations:_:----------"--.- ------ --- *-------------------- ----------............... <br /> ..................I....------------------------------------------------------------------------------------------- ............--------------------------------I.,-------------- -------------- <br /> ----------------------------------------------------------------- <br /> ...........I -----......-• --••-••----.... •-••-----•I---- I----------------------------------------------------------------------------I----------------------------------------- <br /> ----------------_,------------------- <br /> ----- ---------------------------------------------------- -----------­-------------------------- <br /> -----------_------- ................I------------------- <br /> ---------------------------------------- ---------------------------- - <br /> ---------------------------------------------- <br /> ------------------ <br /> Date---- ...... ---------------------------------- <br /> FINAL INSPECTION BY:. ---------_-------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 13.0 South American Street 300 West Oak Street 134 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> CS 9 REVISED 8-139 2M 5-61 ATLAS <br />