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Permit No. <br /> --------------------------- -------------------- APPLICATION FOP, SANITATION PERMIT <br /> ---- ------- ------------------------------ ------------- (Complete in Duplicate) <br /> j Date Issued -J=-—--------- <br /> - ----------------- <br /> ...... --- --- <br /> ------------------ - <br /> This Permit Exl5ires 1 Year From Date Issued <br /> --- -------------- <br /> Applica.fion is hereby made to the.San aoaquin.Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County ordinance No.,5f. <br /> Z4------------------ <br /> JOB ADDRESSeA1qD—tE),�ATI0 --- - ---- ---- ---------- --------- ... <br /> -------- Phone--------------------------- -------- <br /> -- --- -- ------ - ------------------------------ <br /> Owner's Name----------- ----------------- <br /> ----------------------------------------------------------- <br /> Contractor's <br /> --------------------------- ------------- ­----------- <br /> Address-------------- --- Phone----------------------------------- <br /> ctor's Name---------- - ------ --- ------ <br /> Contra --- ------ Commercial Motel ,El Other 0 <br /> Installation will serve: Residence Apartment use 0 Traile�r Court 0 <br /> 3 Number o baths _/---- Lot size ---- ----------------------------------- <br /> Number of living units: Nur�ber }f-bedrooms'- <br /> Water Supply. Public system [I Cor7unYis'jitem [I Private ;;Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: ;Sand El Gravel F Sandy Loam F-1 Clay Loam [I Clay ��Adcibe[3 Hardpan <br /> ❑ <br /> Previous Application Made: (if y'es,dot'11.e--.------ No 0 New Construction: Yes E] No E] FHA/VA: Yes F] No <br /> ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic fank.or cesspool permitted if-public sewer is available within 200 feet.) <br /> I Material.__.._-----------------------""==t--------------- <br /> est well-----J.�V!_Disfay,�e from faun on----I-0__ _____. <br /> Septic 4ank: Distance from near �fl #- ---------- ity--- <br /> No. of compartments-------- -Size Y__ --------Liquid cleptk--------4­ Capaci <br /> I ---- .--Distance to nearest lot line <br /> ------0------ <br /> Disp ield: Distance from nearest well <br /> Distance from foundation--- <br /> Number of lines----- ..-.-Length of each line--------/.jD 4_/---------Width of trench--- --- ------------------------ <br /> P- length--- ----------------------------- <br /> --- ---------4" __Z.' ----Depth of filter material- ...........Total <br /> Type of filter mafeii_1---.7.,-.-.1 -- -- --- <br /> f f d <br /> See Pit: Distance to Disfante!"TQA dation---- - ---------.Distance----1_10---- Distance V to nearest lot line <br /> ij----I-------Uning material__,_,J� Size: Dia --- ---------------- <br /> Number of pits------imeter----------3_1--- Dept k <br /> Cesspool: Distance from noarest,'Well.------.-:-.:,��----Distarfce.-from foundation._.__..____.._.___ Lining material ------------------------- <br /> I ---Liquid Capacity----------------------- ----gals. <br /> El Size: Diameter------------- ------------------------ ----------- ------------- <br /> Privy: Distance froml�nearest well__.._.____..---------- ---------- i...Distance from..nearest building__-------- ------------------------------ <br /> '11 Es line---------- ------- -----�_ 1�� --------------------------I-------------------------------------- -------------------- <br /> ❑ Distance to nearest' ............. .... <br /> o <br /> Remodeling and/or repairing -------- --------- <br /> -- -- ------ --------------------------------------------------------------- <br /> -----------I---------------------------------------------- - ---------------------- <br /> F---------------- ------------------------------------------------------------------------------------ <br /> -----------f-------- --------------------------------- <br /> ------ ------------------------ ----------------------! I------- ti- ---------------- ----------------------- <br /> t . --------------------- <br /> ----------- -------------------------------- <br /> ------------------------- <br /> -------------------------- <br /> ------------------------------------- -------- <br /> I'hereby certify that I have prepared this application and tha+ the work will be done in accordance with San Joaquin County <br /> ordinances, State Kw'j) and rules and regulations of the San Joaquin Local Health.District. <br /> �n Contracto, <br /> - ------------------------------------- <br /> "I------------ <br /> (Signed)----------- --------- <br /> :& --------------(Title)--------- --------------------- -------- -- -- <br /> "D __ <br /> _ -_ Nlj--Ir;�-------------------------- ...... <br /> x;- <br /> BY=--------•-- <br /> (Plot <br /> Y:----------- ------------------------- <br /> P t plan, showing size of lot, location h,f"ystgm in rela n to wells,.6uildings, etc., can be placed on reverse side) <br /> lo .V I <br /> frPR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY_." ------- - - -- -- ---- -------------------------------------- DATE-----J'_7 4n- --------- ---------------------------- <br /> REVIEWEDBY-------- --------------------------- --------I ---- --------------------------- ---------------------------------------------- DATE_----------------------------------------------------- <br /> BUILDINGPERMIT ISSUED_____________________________------------------------- -------—-------------------------------------- DATE----------------------------------r---- ---- --------------- <br /> Alterations and/or recommendations:__.------------------- ------------------------ -----------------------:-------------- ------------------------ <br /> . I --------------------------------------- <br /> ----- -------I........---------------------- -----------I------------------------ ---------------------------------------------------------------------- --------------I--------------- <br /> ;I ­---------------------------------------------------------------------------- --------------------------------------- <br /> - --------------------------- - <br /> -----------------------I_----------- ------------------------- ------- <br /> --- -------------------------------- <br /> ---------- -------------------------------------------------- ------------------------------------------ <br /> --------------------- ------------- ------------------f --------------------------------------- <br /> -------------------------------- ------------------------------------------------------ ------- <br /> --- ----------- -- --------------- --- --------- <br /> FINAL INSPECTION ---- <br /> Date--- ............ ----------------------------- <br /> -------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.mazeltan Ave. 300 West Oak Street 124 Sycamore Street .205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />