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FOR OFFICE-USE: <br /> ------------- <br /> - -------------------------- <br /> APPLICATION FOR- �ANITATION PERMIT Permit No. ------ <br /> ------- ------ --- (Complete in Duplicate) z <br /> ------------- ------------ Date Issued 7�/ ------ <br /> -------------------------- ---- , <br /> 8"u,S 7-A-ae- This Permit Expires 1 Year From Date Issued <br /> ------------------- ---------- - <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work h ein described. <br /> This application is made in complia e with County Ordinance No. 549. 0 -32 f�I (>c N <br /> pc__ -,,, 9 d, &�.......so-UTH---------------— <br /> r D -TF----------- --------- ------- ------- ------ <br /> -P <br /> JOB ADDRESS AND LOCATION_'n --,K <br /> - ------- - Phone------ ----------- ---------•---•.- <br /> Owner's <br /> hone---------------------------------- <br /> Owner's Name----------------•- JPV�1_11---------- 0 .- P�s � <br /> ---------- ---4--e--------------------------------------------------------------------------------------------------------- <br /> ------------------- <br /> Address-------------- <br /> Contractor's Name--------- ------------------------------------------------------------ --------------- --------------- - Phone----------------------------------E;-F—= <br /> Installation will serve:. Residence F-1 Apartment House E] Commercial Trailer Court [] Motel Ej Other [] GARAr <br /> Number of living units: -------- Number of bedrooms -------- Number of baths _--I___ Lot size ----- —-------_-------------- <br /> Water Supply: Public system El Community system E] Private @3--Depth to Water Table /97 ft. <br /> Character of soil.to a depth of 3 feet: Sand U?:15ravel [I Sandy Loam E] Clay Loam El Clay 0 Adobe [] Hardpan <br /> Previous Application Made-' (if ye;,date___­_ ----- --) NoL?--New'Construction: Yes g_--No 0 FHA/VA: Yes E] No <br /> TYPE OF INSTALLATION AND SPECIFICAT16NS- <br /> (No septic tank or cesspool'permiffed if public sewer is available within 200 feet.) 1>9 <br /> k: Distance from -----Distance from foundation-----/0- _--- Material--- OP-------------- 11 <br /> Sept' T y --F <br /> Liquid depfl,_/ Capacity----- <br /> No. of compartments_..___--�L------------Size-3 <br /> Disp <br /> of each line--.....osal Field: Distance of frolinesm'nearest -- -Distance from foundation---- ance to nearest lot line -------- <br /> Number ----------- .. .. .........Width of'trench---------- ---------------- <br /> ---------------- - - Leng�h ---5_0- <br /> Type of filter maferiaI__R_0CK_..__Depth of filter materiai----V--------------.,Total length______-- 15D------------------------- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_---______ <br /> p ____- <br /> Number of ifs_-------------------Lining material---------------------- Size: Diameter------------------i----Depth--- I----------------------------- <br /> El ! F <br /> 1foundation----____-_--___--- Lining material------------------------------------- <br /> Cesspool: Distance from nearest well_________________Distance from C* <br /> E-I Size: Diameter <br /> ---------------Dept h---------- -------------------- --------- ----------Liquid Capacity.:--------------------------gals. <br /> ----------------------- F Distance from nearest building. ................................ <br /> Privy: Distance from-nearest well_--------------------------------------------- -- -------- <br /> Distance to nearest lot line--------------------- ............ <br /> ❑ <br /> Remodeling and/or repairing de:scribel:--------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------- ---------------------- -------------------------------------------------------------- <br /> -------------------------- ------------------------I----------------------------------------------- ---------------------------------------------------------------------------------------------------- - ---------I--- <br /> ----------------:---------- -------------------I- <br /> - ---------------------- ---------------------------------------------------------------------------------------------------------------------I------------- -------- <br /> that the work will be done in accordance with San Joaquin County <br /> I hereby certify that I have:prepared this application and <br /> ordinances, State aws, an �jrules'and regulations of the San Joaquin Local Health District. <br /> I d <br /> and/or Contractor] <br /> -------------------- ---------------- -------(Owner <br /> ---------- <br /> (S <br /> By:------------------------------------------ ----------------------------------------------------------------- -------------------(Title)--- --------------------------------- ----------- ------- <br /> (plot*r.L, 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_7[__r1R_,C?_11------ ------------------------------------------------------------ DATE-------- ------------------------------------ <br /> REVIEWEDBY----------------------------------------------- --- -------------------------------------------------------------------------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED------- I----------------------------------------------- --------------------------------- --------- DATE---------------------------- - ------------------------------ <br /> ions: V ---------C—tq ---JR--pes!-------------------------- <br /> Alterations and/or recommendations:--- 02�45V �:— ------ -- -- <br /> -----------------------------------------I-------------:-i---------------------- --------------------- ----------------------------------------------------------------- ------------ ------------------------------------ <br /> -Tr -------------------------------------------------------------- .......... <br /> .............. ------------------------------------------------------------------ ------------------------ -----------------------------------------:.. <br /> . - iL ­ ----------- ------------ ------------ ------ ----------------------------------------------------------------- <br /> ------------------------------- -------7------------- ­-- --- ------- <br /> -------------- -------I------- -------------------- ------------­------------------ -------------------- <br /> ----------------------- ------------- ............. ----- ------------ <br /> FINAL INSPECTI BY:.- Date-.- ---------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hoxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />