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i FOR OFFICE USE: <br /> !I_- APPLICATION FOR SANITATION PERMIT Permit No. . ,L <br /> ---- -------------------------------------------A.---- (Complete in Duplicate} <br /> ------------------ ------ ---------- -- ---- <br /> 11 -- This Permit Expires 1 Year From Date Issued Date Issued .__-_1 010 <br /> Application is hereby marl'to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is trade In compliance with County Ordinance NoZ17, <br /> 549 <br /> JOS ADDRESS AND LOCATION.. r ��_'"l ..........== <br /> I� <br /> Owner's Name------- -�'�,G.+�_�_.--�_7921 <br /> - - -�'--� --� �------------------------------------------------ Phone....•----------------•.............. <br /> � Address.........-....... -_..�:I��..--•-----���_--r.�t.�G� --------------------------- -•----••-•--••-•-•------------------------------------------ <br /> Contractor's Name------------��___f- ---Yom. ------------- -------------------­---------- •--------------•-_------------••---.-. Phone............................ <br /> Installation will serve: Residence g' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> i <br /> Number of living units: ---e__ Number of bedrooms Number of baths ________ Lot size ------------------------------------________________________ <br /> Water Supply: Public system [g- Community system ❑ Private ❑ Depth To Water Table _______ ft. <br /> 0 <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> I Previous Application Mader`` (If yes,date--------------- --) No ❑ New Construction: Yes ❑ No E] FHA/VA: Yes ❑ No [Ij TYPE OF INSTALLATION'1AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material_______________.-__-__._____---------.-._-_-.---. <br /> No. of"Lompartments-------------------------Size--------------------------------Liquid depth--------------------------Capacity...........---•------- <br /> Disposal�+eld: Distance from nearest well------ ______Distance from foundation_ _Distance to nearest lot Ie�' _`5.-..--- <br /> [� of lines.................. -------_-----Length of each line---------- _ --•---------------- <br /> Tuebe / ` <br /> Type of. <br /> 9 _____Depth of filter material-------/il.... ...Total length----------- <br /> Seepage Pit: Distance to nearest well---------------------Distance'from foundation___f ------__-Distance to nearest lot line.....y_._____ <br /> 1 Number'of pits-------/------------Lining material___ _ ?_.G/C---Size: Diameter__-- Depth-------- -----___________ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation.-------------------Lining material__--.-.-_____-.-.-_________________ <br /> ❑ Size: Diameter--------------------------- ----------Depth----- -------------..... ..................._...Liquid Capacity----------------_---­ <br /> Privy: <br /> ---------------_--- ..Privy: Distance from nearest well----------_--------------------------------------Distance from nearest building------------------------------------------ <br /> F-1 Distance to nearest lot line-------------------------------- - --------------------------------•-----------------------------------• -•--••-------------------------- <br /> (describe): <br /> ---------------------- <br /> Remodeling and/or repairilw g (describe)=---------------------------------------------------------- .............-..............-•--------------------------------------------------------- <br /> --------------------------------------------d-------------------- �----------------------- •- ----------• ----------------------------------------------------------------------------------------- <br /> .. � - r <br /> ------------•---------------------------•--------------------------------------------------- <br /> :. --------------------------------------------------------------------------------------------------------------- -- <br /> I hereby certify that Ihave prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State/jaws; and rules and re lations of +he San Joaquin Local Health District. <br /> ii fI <br /> (Signed) �:'ro ` ------ - ----------=- -- -- -= -- - ----•- (Owner end/or Contractor) <br /> --_--•---------------(Title)---------------------------------------- --- -- -------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTME USE ON <br /> APPLICATION ACCEPTED --- ----- --------------- DATE_,�9----- - -�----------- <br /> REVIEWED BY---------------- 11 t DATE <br /> -------------------- ------------------ ---•------- -------- ------------------------------- <br /> BUILDING PERMIT ISSUED..................---------- ----- -- - ------..-.-------- DATE.---------- .----------- <br /> Alterations and/or recomme ndations:- - --d= ----------- 10 �,c� t ! �' --•-------------------•--------------....--------•------------------- <br /> ------- ---- <br /> i < <br /> -- - ------ --- <br /> --------- 'c••y........ <br /> ---- --oa!d- -------------------- <br /> 1 7--------I-------------------------- <br /> FINAL INSPECTION BY ---------------------------------------------------------------- Date------------------------------------------ <br /> I SAN JOAQUIN LOCAL.HEALTH pISTRICT T. <br /> 130 South American Street 300 West Oak Street e)14 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 2M 5-62:ATLAS <br />