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FOR OFFICE USE: ' <br /> APPLICATION FOR-SANITATION PERMIT Permit No. <br /> -- -- ------------------ <br /> ---------------------­------ (Complete-in Duplicate) G - <br /> ------------------ - ---- -----_---------------- - Issued <br /> Date Issued .l" _=-- ------:� <br /> " This Permit Expires 1 Year From ate <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliarice with County Ordinance No. 549. <br /> JOB ADDRESc, P LOCA Nll> -!�'lLC _ _lCd..vti.._" ____ -._. <br /> Owner's Name_-"_ECS _ <br /> Q -- Phone---------------------------- <br /> Address-- --- v� ------- t-t-t <br /> --•--- ----- --- r --'---------------------------------- �Contractor's Name------ ---- -- ... --- Phone: <br /> ----- -.----- -•-------- <br /> Installation will serve: Residence Apartment House Commercial Trailer Court Motel Other OIL <br /> Number of living units: __r-... Number of bedrooms _Number of baths.__j-.- Lot size --- _.. ... ------------------------- <br /> Wafer <br /> _.......... ......... <br /> ;:# I <br /> 1 Water Supply: Public system ❑ Community system.❑] Private Depth to Water Table ------ - ft <br /> I Character of soil to a depthf 3 feet- Sand.E] Gravel ❑ lSandy Loam ❑ Clay Loam ❑ Clay ❑ . Adobe ❑ Hardpan ®/ <br /> Previous Application Made: t(If yes,date- ..._- ----- } No [] New Construction: Yes ❑ 'No ❑. FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic nk: Distance:from nearest well-_.�1t_......Distance.fromrfoundation .:t-/P...-....- <br /> ( No. of compartments____-._ ..........Size- �'�-f�1�. :�.x"c �Liquid depth__- .� ----- --------Capacity.,�ar°p-.. <br /> Dispas Field: I Distancelfrom nearest well....." a-_�Distance from foundation___tv---- ...:Disfance.to nearest lot lin e`---..--"-.--- <br /> Number of lines-----------1_.-----__--- Length`',of_each.line-- -^.- bG�- l- V/id.t6,.of trench--- - ------r----------------- <br /> Type of filter material-_-__;$K12A.....Depth of filter materiaL_....��_°`____r_.Total length_/fJ.ta._."----------------------- <br /> ��• " <br /> Seepa e Pit: Distanceyto nearest well _-Distance from foundation....... Distance to nearest lot line- ---------- <br /> ine.. ............". <br /> Number of pits.`. -A-----------Lining material.... Size: Diameter---_--3Dept h---j-S...................... <br /> Cesspool: Disfa ce from ("nearest well ----------------Distance from foundation................. ..Lining material.---._-_....._----------"-_.-_..._ <br /> ❑ i Size: Diameter - --------- ----- ------ -Depth--------------------- -----------------------------Liquid Capacity-------------- -------------gals. <br /> Privy: ? Dishce�frcm nearest weh-------------------------------------------------Distance from nearest building------.------------•-------------------- <br /> ❑ Distance to nearest lot line --- ----------- ---------- ----- ---------------------------------- ------------------------------------- ------- <br /> ---------------------- <br /> Remodeling and/or repairing (deSclbe)----------------------- -------------------- ------------------------ ---------------------------- ------------- ------- <br /> r F r I <br /> ---------------------- ------------------------------- - <br /> 1 0 <br /> ------ - ----------'------ <br /> r I hereby cer{ifT that l have prepared this application and that tale work will be done in accordance with San Joaquin County <br /> ordinances, State a ', and rules and regulations of the San Joaquin Local Health District. <br /> I(Signed)------------- _.V0-......... � ---- -- -- ----- - - --- ---------- -----------.---------------------- --.1 - ------- --------------- .. d/or Contractor) <br /> By:------------- -)-------- ---- ---------- (Title) _.- <br /> (Piot plan, showing size of lot, location of system in elation to wells, buildings, etc., can be placed on reverse side). <br /> -; 1 <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED �--------- ----------------------------------- DATE_-4/7_1 '_�I_.-h_ �-- <br /> --- <br /> -------------------- <br /> - <br /> REVIEWEDBY-------------------------- -----P- -------- ------------------------------------------------------------------------ ----- DATE--.-- .----------------------------------------------------- <br /> BUILDINGPERMIT ISSUED.------- ----I------------------------ --------.-- -- --------- DA••TE-----------------------"-- ---- ----------------------------- <br /> 17Alterations and/or recommend tions:-----1 .- G ` ....._..._ _✓�____ o� <br /> ----•-- ------ <br /> - ------------------ --- ---------------------.-. .------- --------- - ---------------------•----------- -------------------------------------------------------------- ---- --------- ------------------ <br /> I <br /> FINAL INSPECTION BY:..- � .� -------------- ------ Date.......... <br /> ---- --. ----------------- <br /> 8' <br /> • ----------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Slocklon,California Lad!, California Manteca,California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br />