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---------- '%MOO <br /> ------------------------------------I------------ <br /> - ----- --- APPLICATION FOR SANITATION PERMIT Permit No. <br /> - ------ 7-----------------------*----------- (Complete in Expires 1 Year From Date Issued 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 <br /> application is made in compliance with County Ordinance No. 549. <br /> lies JOB ADDRESS AND-�CATIP I----e,"-4 t�6 i <br /> 1 6 E <br /> -- ---------- <br /> .......... <br /> Owner's Name..... e6. ------ ---------- <br /> .........I----------------------------------- ---------------- Phone------------------------------ <br /> Address......... <br /> Contractor's Name------ ............._-------------------- ----------------_------- <br /> - ho .................................... <br /> ---------------- -_-- ------------------------------­--------------------------- Wtion will serve: Residence 1� Apartment Hous —-------- <br /> Installa ----------- <br /> Nu0 E] Commercial [] Trailer Court K Motel Q Other ❑ <br /> Number of living units: <br /> ----/_ Number of bedrooms ---2--Number of baths ----)-_ Lot size 2 ey_,,;Z_�rr _4!� .4 <br /> Wafer Supply: Public system [I Community system E] PrivateK Depth to ft. Z/ _------ <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel [] <br /> Sandy Loam E) Clay Loam Clay [I Adobe 0 Hardpan 0 <br /> Previous Application Made: (If yes,date...__..-.._...---) No 0­1 New Con! _0_ o FHA/VA; Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: n\N El <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-----7,0----Distar from foundation-.-_.' -----_Maf; , I <br /> 7L_---------------------------- ---------- <br /> No. of compartments---------21---"­-------Size- -----�12A.A!_.Liquid depth-------- ----- <br /> h. <br /> Disposal Field: Distance from nearest well----- <br /> ZO------Distance from foundation....................Distance to nearest lot lin es-----.Number of lines_----Y---- <br /> - ------- Length of each line-------- Width of trench_A�_*_ <br /> ;�------------------ <br /> Type of filter materrat�5_- X-Depth of filter material length----."1. -------------------------- <br /> see Seepage Pit: Distance to nearest well------------------_Distance from foundation------------------Distance to nearest lot line--- -------- <br /> 0 Number of Pits----- ----------------Lining maferialAj-------------------Size: Diameter.-.- Depth--------------------------- ----- <br /> Cesspool: Distance from nearest well..---------------Distance thorn foundation--- ----------------Lining material... ...........-------------------- <br /> lie. 0 Size: Diameter.__._.--._.----- <br /> . <br /> - - Depth-----------I------------------------------------...Liquid Capacity---------------------------gals. 7% <br /> .0 <br /> Privy: Distance from nearest well__.,.___....... _-..--------------------Distance from nearest building-_--.----.__--. --------------- <br /> F1 Distance to nearest lot line-----------'------------------`------..._---------- <br /> 0 <br /> le. Remodeling and/or repairing (describe):------- -i---------------------------------------------------------- -­----------- ----------__------- <br /> ----------------------...--- ----- <br /> ----------- <br /> --------------­----------- <br /> --------------------------------------------------------------------------------------------------------- <br /> ----------­-----­-------.......--------_--- -------%-•-------------------------------------- ------------- <br /> — --------------__­---------------------------­-----------I------------­­--- --------------------—I-------------------------------------------------------- -------------------------------- <br /> I hereby cert'f" that I have prepared this application ari'di that the work will be done in accordance with San Joaquin County <br /> ordinances, Ste I ws, and rules d rp Mations r' me ions of the San Joaquin Local Health District. <br /> (Signed)._..... ------ ---- ----...... ✓--------------- - ----- ---------------------------- -----.---..--_---.(Owner <br /> ------- -- --(Owner and/or Contractor) <br /> By:-----------------_-----_ ------_----------------------------------- -----------­--------------­--------------(Title)--------------------- <br /> (Plot plan. showing she of [of, 1ation of system in relation to wells, buildings, etc., can be placed on reverse slide). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----------------------------------- - -- DATE-------------------------------------------------------- <br /> REVIEWED BY------------------------------------------------------------------- --- DATE.----�.Z- <br /> --- -- -- ------ <br /> BUILDING PERMIT ISSUED--------------------------------------------------- ---------- ------------------ DATE------------------------------------ <br /> y Alterations <br /> ATE-------------------------------------Alterations and/or recommendations:-- ----------_----- ............-------------_------------------------------------------------_-------------------­ <br /> 6 --------------------------------------- .......................----------.....................----------------------- ----------------_-----------------­------------------ ...­........------------------------------.....-- <br /> I <br /> ----------------------------_----------------------------­---------­­­------------------ ------------------------ ------------------­--.................­_---------------------------------­----------- <br /> ----------------------------------------------- -------------------- - -------- -------------------------------------------------------------------------------------------I----*---------------------------------- <br /> ------------------------------------------ <br /> -------------------------------------------- ---------- ------------ .---------------- ---------------------_------------------------------------------------------------ <br /> FINAL INSPECTION BY:.---_ --- ---------- Date --------------------- <br /> ---------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. tisn,ell..Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Sissm.,California Lodi,California Manteca,California Tracy, California <br /> CS 9 P.11.s. .-Se 3. 3-'63 <br />