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FOR OFFICE USE: <br /> ---------------- SANITATION HERMIT Permit <br /> 9LICATIONTOR SAN ..No. <br /> ----------------- t, <br /> ---------- <br /> ------- =,j,L-AAl D---b4__- (Complete in Duplicate) e --------/1---4/ <br /> .1('boo Qate Issued <br /> --- -------------------------------------------- This Permit Expires 1 Year From Date Issued (&--o-0? <br /> plication is hereby made the Son Joaquin Local Health District for a permit to construct and install the work herein described. <br /> I ap at If is maid in plianc'e with CounStce No. 549. 6, 64- <br /> A <br /> .. .. ... . ... <br /> 1 7- <br /> DTOCA --- --- - --- ------(__� <br /> Owner's Name_ --- - ---------- -------------------------------------------------------------------------------------------- Phone---OR_729-Ir/--- <br /> Address__..P..,0 ------------------------------------------------------- <br /> ---------------------------------------------------------------------------- <br /> Contractor's Name__ _ -------------------------------------------------------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence [j Apartment House [:) Commercial Ej Trailer Court [] Motel [3 Other toey-46ft- <br /> Number of living units: -------- Number of bedrooms -------- Number of baths-__-t---- Lot.size ---._;_-•_-------------------------__--.-.- - ----------- <br /> Water Supply: Public system [] Community system El Private E] Depth to Water Table ft. <br /> Character of soil to a depth of 3 feet: Sand 0 GravelSandy Loam Do Clay Loam E] Clay E] Adobe [j Hardpan C] <br /> Previous Application Made: (if yes,date---- ------- ---A-T) No 0' ' New Constirm0ionX-es-R No ED FHA/VA: Yes [] Nop <br /> TYPE OF INSTALLATION AND SPECIFICATIONS; ei <br /> -'4-LL'#-, i A4 110 <br /> No septii-.'-fadkl�!�r cesspool Pparesf <br /> ermitted if puOic,sewer is v,6111able itkin 200 fbet.) <br /> SepticC.e ounclVion---- ------Material-----C0_/J._C,_t--- <br /> Tank: Dist from from f�- V .4 ----11 ILiquid depth-------4...... --------C pacity----0 <br /> No. of ompartfn&ts__.___.a---- 0�5 <br /> t if e - ---------19---- <br /> Disposal Field: Distance from nearest well_.,3�p---4.-Vifance from foundatiFp----57_!---1-----Distance to nearest lot line----------------- <br /> Number of lines----------a.--------------*---*Length of each line------�15�-5.-�------(--_Width of french--------97-qz________f7. -1? <br /> T pe of filter material 0 41a IL 6pth of filter Aaterial.. 1-9......!-----Total length____j,5;W...... 7,! <br /> _Dp ---- -- <br /> .,4 A -_ - A <br /> See pa'ge 7,..� well ce <br /> Pit: ADisfance to nearest --------- ---/Distan from foundatiof�r� ---------L_Distance to nearest lot line-'.------------ <br /> Sizi Ibiamete'r------ <br /> in T -ifs -i* <br /> El Numb r Pbf�p - -------------------Lin n material a: -------- --------Depth--------------------------------- <br /> ---------------- <br /> ❑ <br /> Cesspool: Dis ance ti!est well --------------Distance from foundafionkef-----!-_.Lining material_____________________________________ <br /> Size�-ID2�4ni -1 W 0 Depth------------------t................r--------I----Liquid Capacity----------------------------gals;- <br /> -4 <br /> Privy- Distance from he-arbst we........V17 -----------------------------!--Distance from nearest <br /> building------------------------------------n.. <br /> F1 Z411)isfahce to near'e,f lot line---- ----------------------------------------- --------------------­------------ ----------------------------------------- <br /> .41. <br /> Remodeling and/or repE:1ir4i@n <br /> -----------------------------------------------------------------------------------*------------------------------------------------- <br /> ---------- _x, , I <br /> ------------ ---- ----­---------------------- ------------------------------------------------- --------------------------------------------------------------------- -1 ----- <br /> ­* ----------------------------------------------­-------------------------------------------------------------------------------- <br /> ------------------------- --- A-------11.1 <br /> -------------------------- --------------------------w------------I------------------------i------------------_----------- <br /> tsoi 111i, I ---------------------------------------------------------------------------------------------- <br /> I hereby certify that I have prep'ared,this a -olication and that the work will be done in accordance with San Joaquin County <br /> y application. -A <br /> ordinances, State laws, and rules and reg6lifions of the San Joaquin Local Health District. <br /> (Signed------ -------- ---------------------------------------------------------- -(Owner and/or Contractor) <br /> B -------------(Title)----------------------------------------------------------- <br /> n - ----- -------------------------- ----------7--------------- <br /> (Plot showing�__iozeiclorf. ioca io�_n__O�__sys�e__M in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> . ....... <br /> APPLICATION ACCEPTED BY........ 11 - ------------------------------------- DATE------- -----------41-1 <br /> REVIEWEDBY--------------------------------- ---------- ---------- --------------------------------------•----------------------- DATE-------------------_---------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- <br /> Alterations and/or .1. <br /> m endations--------------- --------------- ------------------_----­-------------­­------------------------------------------- <br /> -------------------------- <br /> ----------------- -)-----------------t-------------------------------- <br /> -------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------- <br /> -------------------------- ---------- ----- ----------------------------- ------------------------------ --------- ---------------------------------------------------------------------------------------­------------- <br /> --------------------------------------------I-------------------­-------- ...................................................... ........................................................I——---------------------------- <br /> FINAL INSPECTION BY:_ -- <br /> ------ 'Date..../----------- -6 ...?-—------------ ..... ------------------- <br /> SAN J OA Q__ <br /> UIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />