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FO FFICE USE: <br /> -- -------- aA. - 7 <br /> r "3 s APPLICATION FOR SANITATION PERMIT Permit No. .____ <br /> 7 �_ ------------ 1/-- -- <br /> - l � -- �'- 1 (Coinplete in Duplicate) Date issued <br /> j This Permit Expires 1 Year From Date Issued <br /> p i� ion is hereby t a e the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> a <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION----____.__ _ <br /> =----- ------- --- ----- Phone-----•"l/�/�-•-------•--- <br /> Owner's Name--`=-------------- 1 T��------- ---�- - --T =ul <br /> - -------- - <br /> ------------------•--------- <br /> Address-------------------- ,' <br /> E --- Phone----------------------------------- <br /> Contracior's Name------------ ------ " <br />! Installation.will serve: Residence j Apartment House ❑ Commercial ❑ Trailer Court El Motel ❑ Other El <br /> Number of living units: _ Number of bedrooms _ <br /> Number of baths _ _ "-- Lot size ---- — `C1---X--•-. .5 --------------- <br /> Depth to Water Table ft_ <br /># Water Supply: Public system []t' Community system ❑ Private ❑ p <br /> f ❑ ❑ y Clay Loam Cla Adobe Hardpan ❑ <br /> I Character of soil to a.depth of 3 feet: Sand Gravel Sand Loam ❑ y Y ❑ ❑ <br /> Previous Applicatiori Made: (If yes,�date----- ------------I No �ew Construction: Yes ❑ No [ FHA/VA: Yes ❑ No [�-� <br /> i TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> _" ___"___Distance from foundation__-_IR_- ".Materia4----_ �a!G7Gg --------- <br /> Septic T k: Distance from nearest well_____- - Capacity--- <br /> -- <br /> , �' g•---Liquid depth- �f -----No. of compartments..-_--" , ----------- Size__._ .. <br /> Disposal eid: Distance from nearest well___.^---- Distance 01 <br /> from foundation__ -"---.- Distance to nearest lot li e ""..-- <br /> Number of lines--------""-.�- -----Length of each line-------6�-------------Width of trench-----. ------------------ <br /> `-- Total Oen th_____ <br /> Type of filter materia4___ ZZ. ---Depth of filter material___ "____ -_- g -------- ------- <br /> Seepage Pit: Distance to nearest well__-_--,_-____-_____Dista ce frgfn <br /> fo dation___��----------Distance to nearest lot line­ <br /> ------- <br /> ine""a ---- V <br /> 1 Number of pits---------/---------Lining materi I _93z.-- size: Diameter--- __`_�_.-----.Depth--- ---- w <br /> Cess ool: Distance from nearest well----------------- rom foundation__________________.Lining material______________ als. <br /> p --De Dept -Liquid Capacity- --------------------------g 7< <br /> ❑ Size: Diameter ------------------- ------ p <br /> Ig--- ---------------------•----- --------- <br /> Privy: Distance from Barest well_._._.______------------------------ Distance from neatest buildin <br /> ❑ f Distance to nearest lot line----- ------------+�--------- ------------------------ <br /> - <br /> - O <br /> ------------------ <br /> # Remodeling and/or repairing (describe):----,// ----- ---- <br /> -- -- ----------------------------------- ----------------------------------------------- <br /> ________ __ _"-_____ __ _.---"_ _ <br /> 1 hereby certify that I ha lependaregulations regulations <br /> the San Joaquin hLocalkHeawill <br /> ltheDistr cidone n accordance with San Joaquin County <br /> 3 <br /> ordinances, State laws, s <br /> f� / �/ _- wne nd or Contractor) <br /> (Signed)-------------------------- :� <br /> " L { —S f rrl ---------- ------- <br /> (Signed) <br /> ------ / <br /> y (Title) <br /> ----- --- <br /> Plat tan, showing size of lot, location of stem in rek ________________________" <br /> ! g _ ---- <br /> ( p ation to wells, buildings, etc., can be placed on reverse side). <br /> 1. F R DEPARTMENT USE ONLY <br /> DATE----------� �-- ------� --------------- <br /> APPLICATION ACCEPTED BY----------- - ------- ----- <br /> DATE----------------------- --------------------------------- <br /> REVIEWED BY - DATE <br /> BUILDING PERMIT ISSUED-------------------------------- <br /> I J2 - ------- �a�� - <br /> Alterations and/or recommendations:__"____ -- -- <br /> fg __ -- '------ <br /> ----------------------------------- <br /> ------------------- <br /> 31.7gl•-�-~rte ' <br /> --------------- <br /> ----------------------------- <br /> s <br /> Date-----3 � i✓ .��.. ------------------ -------- <br /> . " <br /> ------ ---- - <br /> FINAL INSPECTION BY:____ "-. _-."-- ---- ---- -«—` <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1401 E.Haxelton Ave, i 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California <br /> Lodi,California Manteca,California Tracy,California <br /> ".Ca. <br /> z f <br />