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FOR OFFICE USE: <br /> --------------------------------------------------- <br /> � � <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br />---------------- -------------------------------------- <br />------------------------ --------------- -------------- (Complete in Duplicate) Date Issued <br /> ­------------------ This Permit Expires I Year From Date Issued <br /> -------------------------------- <br /> ,A�pplication is hereby made to the Sa6Joaquin Local Health District for a permit to con Vruc4tan �install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. 2_3o-ol <br /> j4E <br /> ..... ..........�7 <br /> JOB ADDRESS AND LOCATION ---------/, ----•A . <br /> OwnersName.. ------------------------------------------------------------------------------- Phone-------------------__--------- <br /> ........... <br /> -------------............................................................................................. <br /> Address............ ..... ..... - --------------Arl <br /> Contractor's ---------------------------------------------------•------------•-=_----•--•---.....---••-•-----...._... Phone..--------------------------------- <br /> Installation will serve- Residence U3 Apartment House El Commercial El Trailer, Court [3 Motel C3 Other'E] <br /> Number of living units: J----- Number of bedrooms _4--- Number of baths Lot size -------- <br /> Water'Supply:- Public system � Community system E] Private 0 Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam El Clay Loam F1 Clay p Adobe[] Hardpan <br /> Previous Application Made: (if yes,date----------------__) No New Construction-. Yes � No [3 FHA/VA. Yes P No <br /> ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS; . CI <br /> CIP <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> ......................... <br /> .Sf,,P+ic Tank: Distance from nearest well__47�__*_._Distanc9 from founc1atiQn___.J_4----------Mater ial- ty&_".. . . <br /> No.' of compartments----- L------------------Size_ Liquid depth......6 ------------------Capaci Z! <br /> est lot <br /> Disposal Field: Distance from nearest well$' <br /> A�-------Distance from founclafion.1.4...........Distance to near <br /> Number of lines "Cength, of,each line------"_Q_-------------Width of french.... ........--­--------- <br /> Type of filter mai I - ----------F .___4i' '___........................ <br /> - -------Depth o ter maierial----1110________"_____Total longth..- <br /> D th f fitter <br /> Seepage Pit: Distance to nearest welL/ ...........Distance from founclatibn...JA----------Distance to nearest lot line--tr--------- <br /> Number of pits----.X, -------------Lining material-/1,4 e: Diann ......... <br /> -----------Si z eter____43w_ ----------Depth-,2,f------------ <br /> Cesspool. -orn nearest well--------------- Distance from foundation._.__------_-----Lining-material_..___--_____._.."____-.----_____. <br /> Di:tance from 4 --gals. <br /> 0 Size: Diameter---------------------------------------Depth----------------------------------------------------Liquid Capacity..--------------------I— <br /> t - 177� . ---------------------------------------- <br /> J <br /> Privy: Distance from nearest well------------------------------------------------iDistance from nearest building <br /> Distance to nearest lot line-----------•---------- ----------------------------------­--------------------­---I------------------------------------- <br /> ❑ <br /> Remodelingand/or repairing (describle)*---------------------------------------------------------1�---------------------------I------------------------------.................................... <br /> I I ---- <br /> ------------•----­-----1------------- <br /> ........................I------------------------------- <br /> --------------------------------------------------------------------------------------------------------------- A x. - ------------- ---------------I—------------ <br /> -------------------------------I---------------­---------- --------------------------------------------------------------­------------ ..... ---------------------- <br /> ------------------------------------ --------------------------------------I-------------------------------------------------------------------------------I---------------------1-1-1*11------ ----------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances. Ufa laws, and rules and regulations of the San Joaquin Local Health District. <br /> -- --------------------- ------------- -------------_---------------(Owner and/or Contractor) <br /> (Signed)--------A4A�---- - -- <br /> By:---------------------------------------------------------------------------- -------------------------------------------------a <br /> ---(rifle)---_------------------------- ----•-------- ------------------ <br /> (Plot plan. showing size of lot, locati�6 of system in relation to wells, buildings, etc., n be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> 2-6 <br /> --- ---------------------------------­-- ------------ <br /> APPLICATION=C�EPTED �BY___ - ----------------------------------------------------------- DATE <br /> ' DATE-------------------------------------------------- <br /> REVIEWED BY--------------------------------------------------- ........ —------------ DATE. A----------------------- <br /> BUILDING PERMIT ISSUED------------- ----------------------------•---.....----- le:b------ <br /> 6 --------S------------------ <br /> ---------- ------ -------- !Jw <br /> Alterations and/or recommendations:----- -17.1----1-0------ ---------f._�___4............... ........... . <br /> --------------------------------------------------------------------------------------------------------------------4......---------------------­-----v-­------------ <br /> -----------------------------------:----------------------------------------------------__---------- <br /> ------------ ------I------------------------------------------------------------------- -------------I--------------_ <br /> -------------------------------- <br /> -----------------------------------------_---- ------------ <br /> ­------------------------------------------- ------------ ------------------------------------...,.........I....................I------------------------------------------- <br /> ------------------------- ------ ------ ------------ ---------------------I---------------------I---------------------------------------------------- ----------------------------- --------------------- <br /> ------------------- - -------------------------------------------- <br /> FINAL INSPECTION BY:. ---------------------- --------- ------- ---------- Date------------ <br /> SAN <br /> ate------------SAN, J OQUIN LOCAL-HEALTH DISTRICT <br /> 130 South American Street i 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,Coll4mia Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED S-59 214 6-61 ATLAS <br />