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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued --:01 <br /> 2606 5.,f. .r>�s S6/j_,", ­2�A- 3 IF40 2-- C)t 0 <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 compliancWifh County Ordinance r, 549. <br /> > <br /> JOB 'ADDRESS AND Of -------- <br /> Phone----------- ---------------- <br /> Owner's Name------ ------------------- ----------------- ----------------- --- -------------- ------------------ <br /> 7 0_d <br /> Addre <br /> ---- -- Phone <br /> Contractor's Name-------------- <br /> ------------------ <br /> ----------------- <br /> Installation will serve. Re iclence,14,.Apalrtmen't House E] Commercial El Trailer Court E] Motel Cj -Other El <br /> UL <br /> --------------- <br /> Re iclence�5 <br /> Number of living units: --/-.---Nber of bedrooms ___:Number_ <br /> -1�u <br /> ummber of baths 'Lot size _ __fes- ________i ---------- <br /> Wafer Supply: Public system 'O' Communify_systeqr�- Rrivafe [:] Depth to Wafer Table -------- ff. <br /> Sandy'd y'-Lb-a rn FCly L7—❑-CI9-y- cIoF,;j�<H;rdPan L <br /> Character of soil to a'depth of 3 feet: Sand E] Gravel I oam <br /> 0 <br /> Previous Application Made. Yes [] No�New'Consfruction: Yell)4No E] PHA/VA: Yes Ej No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) <br /> Septi Tank: Distance <br /> istance from:nearest <br /> tI'e. l D <br /> i­fa' <br /> nce f <br /> rom f6undtion--Z- -'F---'.MateriaI----- <br /> . o -- paI . , -------------- - -Six _ Liquid depik_, k Capacity s <br /> NofcomrtmenTS <br /> D15p0slFied- Distance from nearie11 r Distanc,�rom f ,ndaf[OD-110!)... Disfance to nearest <br /> lot ------ <br /> ---- <br /> Number of'of lines __'.Width of french_ ------------ <br /> Nu­m'� NAFAt L th o� each line_46W-MM1Tr' <br /> of filter - - - Pg J <br /> e <br /> DZpth,of'filter materia!__ -- ----Total lengfh­w_-Y440�_�_ <br /> - <br /> Type --- -------4 1 <br /> eare -da� <br /> "Distance to n" St well___________________---- -----Diitance frorWfo7n tion-------_-------- <br /> Seep 9" -P;�': , - I _Disfance to nearest lot lin e , g a ------; <br /> _1 Number of pits_ --- ------V------Lin�n ,11U <br /> material-----------------------Size:Size: Di 'meter------ ---------LDepfh--------------­­---------- ---- <br /> Cess�ool- Distance from rearesf!N�ell -----------'-Distance from foundatioi!!_______________Lining material-_____..___._____________-. <br /> !----------1�-------- it <br /> qv L-'f --- --------Liquid Capacity-- ------------------------ gL, <br /> ❑ Size: Diameter--- ---------- ------------De'pf h----------------------------------- ------- -- <br /> T <br /> from Privy: Distance from neares%well ---------- - --------------------------- --------Distance nearest building_-_ . -------------- <br /> DistancetonearestlotLli e------- ----------- ------------------------------------------------------------------------------------------------------- - <br /> 7. <br /> - -----------I-------------- -1- ---------- -------------------------------- <br /> Remodelin�"and/or repairing (cle -------------------- •---•-------•-----`-------•--•-----� --- <br /> ---------------- <br /> - ---------- - 1*-- --------------------------- ------------------------- ------------------------------ <br /> - ------------------ -- - -- ---------- <br /> ------------------------------------ -- ---------------------------------------------------------------------------- ---------------- <br /> ---------------------------------------------------------------------­_ _e Z <br /> I here6y,cerfify that I have prepaired f is application <br /> S:'n"I!, the work will be done in accordance with San Joaquin County <br /> ordinances, State lawi, and rules and regulations of the uin Local Health District. <br /> DAY &NIGHT <br /> (Signed)..-.- ------------So-ptic-Tank4em4ca------------------ ---- --- - - -------------L------------------------------- mpal* Contractor) <br /> NO2-704t, Title----------- ------------------------------------ -------------­- <br /> By:----- - --------------------sf---ky-------Cof---------------------- ---- ----------- ----------L -----------(Ti <br /> '9(Plot plan;-showli size of lot, locIA10"Onof sy's ein in relatio to-"" 0 (dings fc.,-can,be,placed-on reverse side). <br /> 1 0 �Z�" 7 <br /> FOR E&ARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY DATE----- <br /> ------------------------------------------- <br /> - ------ ---------------- ---------------------------------------- D - <br /> ---- ------------ ------ -- <br /> - <br /> REVIEWEDBY---------------------------=--1--- -------------------------------------------- -------------------------------------------- DATE--------- -------------------------------------------------- <br /> BUILDINGPERMIT ISSUED---------- -------------------------------------:----------------------------------------------------- DATE----- ---------------------------------- ----------------- <br /> Alterations and/or recommendations-------------------------------------------------------------------------------------------------------------------------- ---------------------------- <br /> ► <br /> -----------------------------------------------------------I---------------------- -----------------------------------------------------------------------------------------------­1----------------------- <br /> ----------L--------------------------------------------- ----------- ------------------------------------------------------------I--------------------------;---------- <br /> ------------------- ---------------------------- ----------------------------I------------------------------ <br /> ------------------------------------------------- = --------------------------------------------------- <br /> ----------------------------------------------- --------- ----------------- ------- -------------------------------------------------------------------- --------------------------------------------- <br /> Ife --------------------------------- <br /> FINAL INSPECTION BY------ -----------11---------- ----- De ------ ------%go- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street- .132 Sycamore Street 1 814 North "C" Street <br /> Stockton, California Lodi, California- t Manteca, California Tracy, California <br /> ES-9-2K4 Revisoci 1.57 FY.CO- <br />