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rvK Urrrljt; jbj:: ............... <br /> ------------------- -------- -------- -------- <br /> ------------------------------------------------:�------- APPLICATION FOR SANITATION PERMIT <br /> --------------- <br /> ---------------- ------------------------ Permit No, 113e9S <br /> (Complete in Duplicate) <br /> - <br /> ----------------------- ------------------------- ------- This. Permit Expires I Year From Late 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 /> • t) <br /> This applicafion.is made-incompliance-with County Ordin nce No. 549. <br /> L J <br /> JOB ADDRESS AND WC.ATION----- ------ec, <br /> __0_zF <br /> Owner's Name ------- - ---------------------•------------------- ------ <br /> Address..' _ �;07--—---------------------------------------------------------- - -- ------------------------ ------ Phone--------------------------•-=--•-•-- <br /> - <br /> _��------------------------- <br /> --------------------------------------- .1. I <br /> Contractor's Name " V --------------L------ ---------------------------------------------------------------------------- <br /> ­�q-------------jr-*,_­--0'Lie"�---------------- ------ --------------------------------- Phone... <br /> Installation will serve: Residence [M-Apartment House E] Commercial Trailer Court E] Motel ❑ Other <br /> Number of living units: NumbEl <br /> Number of bedrooms Number'of baths Lot size ------10 <br /> ----------------------------- <br /> Water Supply: Public system E] Community system Ej Private & Depth to Water Table _jA ft. <br /> Character of soil to a depth of 3 feet: Sand E- Gravel 0 Sandy .Loam Ej ClaLoam Cla <br /> E] y E3 Adobe[3 Hardpan. ❑ <br /> Previous Application Made::, 0f yes,date------------------ <br /> --) No � New Construction':y Yes [I No [A�- FHA/VA: Yes E] No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> septic tank or-cesspool-perrniffed-if-public-sewer_is-available.wi+hin-200-feefr)zi.--------�-- <br /> Septic Tank: Distance from nearest well__i5.0Pe._ <br /> -Distance from foundaf -.Material----- ------- <br /> No. of compartments-. ----------------- ---Size-------•- -------------I------- Liquid depth.-- ------------------- ------------- <br /> -------------- --------Capacity----------------------- <br /> Distance:from nearest -well., <br /> from foundafion__/_1'-.t <br /> Number of ii -----------Distance to nearest lot line---4'-�` <br /> nO5-------- ------------------Length of each line-----e51--" <br /> --9 <br /> -------YA �4'r__:Depfh of filter maferiaI-­ 9..........Total lengA__11� <br /> Type of filter material "---- <br /> ------Width- of french-.- <br /> Distance'Jo nearest <br /> -------Distance from foundation�4_0-------------- Distance to nearest lot <br /> Fl Number Of pits-----/---------------Lining ............Size: D-��ter_2-_Y" <br /> Cesspool: Depth_19. -nearest well-----------------Distance from founcidtion-- --------- <br /> ❑ Size: Diameter ----_.Linin rnateriaL._".... ---------- ----------------­. <br /> Privy: Distance,from nearest well_______________________-_- Depth ---------------- ------------------------L............Liquid Capacity----------------------------gals. <br /> El Distance ' line________ <br /> --- -------- _-Disfance from nearest building--- ----------- <br /> to nearest lot line- ------------------------------------------------------------r --------------------------- <br /> ---------------------------------------------------------- ----------------- <br /> Remodeling and/or repairing' {describe}:____.________._---------------------------------------------- <br /> ---•-----•-----•--- <br /> ---------------- <br /> - <br /> ------------------ --------------------------------------I_ <br /> I ----------------------------------------- <br /> ----------------------------------------------------------------------------- <br /> - ------------------------------------------------ -------------------------------------f. I <br /> ------------------------------------------------- --------------------------------------------------------------------------------------------------- <br /> ----------------------------------------I----------------------------1,------------- k ---•----•---------hereby certify that I h�hve prepared this-'app'licafi- ' ------------------­------------------------ <br /> will be done in accordance with San Joaquin County <br /> .and rules and regulations of fhelSan Joaquin'"Local -Health District. <br /> ordinances, State laws, on and that the work <br /> (Signed)------ > <br /> ........., A -------------------------------------------------------------------------- <br /> Y. <br /> ..... ------(Owner and/or Contractor) <br /> ------------------- ---- <br /> ----------------------- ------------------- .......... <br /> (Plot plan, showing size of lot,-location of system in relation to wells, buildings, etc., can be placed on reverse side)....... <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_ ._---- <br /> REVIEWED BY---- Y .. ------------- <br /> --------------------------------------- <br /> -------------------------------------- ------------------------------------­.--------- DATE---- <br /> BUILDING PERMIT ISS ---- --------- <br /> UE --------------------------- <br /> -- ------------------------------------ --------------------------------------------------- DATE----------------------------- <br /> Alterafions and/or recommendations:._______ --------------- -------------- <br /> -----------------------------------------------------------------------------------------------------------­------- ----------------- <br /> --------------------------------------I----------------------------- ------ --------- --------------- -------------------------------- -------------------- ------------------ -------------------------------------- <br /> -------------------- --------------------------------------------------- ---------------------------- ----------------------------------- ----------------- ------------------------------------ -------------------------- <br /> ---------------------- ------------- ----------------;-*----------------------------- - <br /> --------------------------------*--------- <br /> - -------------- --- --- -------------- --- ---------- ------------------------ -------- --------------------------- <br /> ---------------------------- ----------- ---------------------------------------------------------------- --- <br /> --------------------------------------------- <br /> FINAL <br /> - ------ --------- -------------------------_-FINAL INSPECTION BY:.. <br /> -------------------- --:------------------ <br /> -------- ----------- -------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Nalelton Ave. <br /> .4 300 West Oak street 124 Sycamore Street <br /> Stockton,California .1 205 West 9th street <br /> Led;,California Manteca,California <br /> Tracy,California <br /> F.P.C O. <br />