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FOR OFFICE USE: <br /> -------------------- <br /> --------------- <br /> APPLICATION FOR SANITATION PERMIT Permit NO. <br />---------------------------- ------------------------------ (Complete in Dup' llciife) <br /> Date Issued <br />---------------------------------------------------- This permit Expires I YeayeFrorn Date Issued <br /> Application is hereby made to the San Joaquin Local Health Districtffor a permit to construct and install the work here c 0 ed. <br /> Th,s e jp-comp iance w! <br /> .application is mad I" ;dw, County Ordinance No. 549. 057-C 0,9-0 <br /> 7 <br /> JOB ADDRESS AND LOCATION. _1_,1_A?19.-t____,11_ <br /> -------------&-10- 7------------- -- ------� ------------------------ <br /> Owner's Name------------- ---- ----- <br /> ------ -- --- ------- -- - - ------------- ------------.-- Phone-- ------- <br /> Address------------------------- ---- -- --- ..... dne- --------- <br /> ----------------I------------ -------------------------------------- <br /> - <br /> Contractor's Name------- ----- - - --------------------------------- Phone.!��f <br /> ------- <br /> Installation will serve: Residence..I Apartment House ❑ Commercial E] Trailer Court [] Motel El Other El <br /> Number of living units: Number of bedrooms __��Number of baths __/__ Lot size ----- --------- ------------ <br /> Water Supply: Public system Ell Community--system-E]-Private [g Depth to Wafer Table 230 ft. <br /> Character of soil to a depth of 31eet� Sand [] Gravel E] Sandy Loam El Clay Loam �' Clay E] Adobe[] Hardpan El <br /> -�,W 1 -6. <br /> Previous Application Made: (if)As,date------------ NoZ New Construction: Yes E] No 11f F' A/VA- Yes M No El CO <br /> TYPE OF INSTALLATION AND.:SPECIFICATIONS: N <br /> .(No septic tank or cesspool per�initted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from neare-�f,...may......ll ---------Distance from foundation------------------- Material---.--__---__-_.__..____..._________.._---__-_. <br /> El No. of compartments--------------------- Size--------------------------------Liquid Liquid clepth--------------------------Capacity----------------------- <br /> 11. k6 <br /> Disposal Field: Distance from. nearest Distance from founclaf ion---XO_�-------Distance to nearest lot line_:47��----- <br /> Rj Number of lines_ I/ - - ---------Length of each line----- Width of french..-. - r' --------- <br /> Total length_________AkP---------------------- <br /> Typ e;,��__N,Depfh of filter material--/ <br /> Type of fiIfer!,af,"riaI___eA <br /> Seepage Pit: Distance To nearest well-------V _sDi'starice f/m -foundafion__49------ Distance to nearest lot line.... ---- <br /> �4 -.0 -Size: Depfk--- .2.5--1 <br /> Number of piifs� ----------Lining maf96aI-:5,' ---------------- <br /> Cesspool: Distance fi,om nearest well-----------------Distance fromfoundation----------- ........Lining•material-- -----------_---------------------- <br /> El Size: Dia'rnef2 <br /> r--------------------------------------Depth-------------- ---------------------- -------Uquid Capacity---------------------------gals. <br /> Privy: Distance from nearest well---_------------------------_---______ Distance from Distance to nearest 1nearest(building----N------------------------------------ <br /> 171 line_______________--- <br /> ---------------------------------- --------------------------------------------------------------- ---------_ -------- <br /> 77fi <br /> n (&I�5crib' <br /> Remodeling and/or repairing I ----4:v 1- -je'll ---- <br /> , <br /> -------------------------------------------------------N_:_Ij I -------------------------------------- ---------------)--------- -------------------------------------------------------------- <br /> ----------------------------------------------m------- -w------ -------------------------------------------------------------------!------------------------------------------------------------------------------------------ <br /> ------------------------------------- ----------I .II -1--2-1.------------------------------------------------------------------9-------------------------------------1---------------------------------------------- <br /> I hereby certify that I have prepared repared this applica i and that the woo will be done in accordance with San Joaquin County <br /> ordinances, State i !,and,rules!and regulations the San Joaquin-Zc(cal Health District. <br /> ----------------- --- <br /> < <br /> < ... <br /> S.1 <br /> (Signed)----------------------- . .... --------------- --- --- er /or Contractor) <br /> By:-------- fes -------------(Title)-------- ---- --- ------- ---------------- <br /> --------------- ---------------------------------------- ------------ <br /> (Plot plan, showing size of lo , locat n of sys'f6ffi'in"relaf ion fo'wells,'buildings, etc., can be placed on reverse side). <br /> _,--/-Or Contractor) : <br /> Tions <br /> side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ---------------------------------------------------- DATE--- - ---------- -------- <br /> - <br /> --------------- <br /> ..................... .. <br /> ------------------------ <br /> REVIEWED BY-------------- --------------------------------------------(-- = DATE DATE------ ........... ---------------------------- <br /> ------------------------------ --- <br /> BUILDINGPERMIT ISSLIEDJ-------IIA--------------------------------------------------------------------------------------- DATE,_-------------------------- --------------- -------------- <br /> Alterations avid or recommetidati. ns _ <br /> -------- --—. --—---- ---------------------- - - ---------------------•----------------------- <br /> - --- <br /> ----------I------------------------------------------ -------------- --------- \ Vh <br /> ---------- <br /> ------------------------ <br /> '11,1 i- <br /> ----------------------------------------- ------- ----------1------- ------ 1 -----------------------------------------------------------------------------------*------------- <br /> ------------- --------------------------------------------------------- ---------------------------- <br /> -------------I----------------------- ...................:11,------ -------- ----------------------------------------------------------------------------------------------------------------- -------------------------- <br /> -- ------------------------- --------------- ------ -------- -------------------------- --- ------- --------------------------------- ----------------------- --------------------------------------------­­­---------------- <br /> FINAL INSPECTION BY----------- ............. —----------- Date------ --- - ---<_.---------.------- <br /> t ------ ------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />