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APPLICATION FOR SANITATION PERMIT <br />Permit No. ------ ?..4-74..... <br />(Complete in Duplicate) Date Issued IN­_,�--.�---• <br />b made to the San Joaquin Local Health District for a permit to construct and install the work herein described. k <br />Application is hereby <br />This application_is_ made in_complianc i ' C unty Ordin 'ce No. 54 D ! �O -d <br />.: R ----- - <br />6 <br />r'�.6' N • . K.t s-f-{w.►�'`(-�. •fit `�' � -A-- �-----�------------------•---...... ----- .----- -JOB ADDRESS,A LOC TIO _, <br />Phone.........._ -•--•------••--•- <br />Owner's NSme----- �j ••••-----•---•----------------------------------------- <br />.P - <br />IJV'_.-- ------•-------------•-----•- <br />.r__:�.. <br />.Address.-- - - -••--- ---- ••---•-- ._......__ _.... <br />- •"------------------ <br />----------------------------------- one..-•---••-----•-- <br />------ ----------- <br />Contractor's Name. ....-•---------- ----•- - -------------------- -----•--otel ❑ Other ❑ <br />A artmen+ House ❑ Commercial [] Trai4er Court ❑ 1 <br />Installation will serve: Residence P t� <br />._- { <br />Number of living units: _�__.._ Number of bedrooms ..___ _ <br />" Number o � a+hs _ ___._- Lot site _"-- ••- - <br />Water Supply: Public: system ❑ Community system [] Private Jgr Depth to ateeraTable -Clay f Adobe ❑ Hardpan ❑ <br />Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Y <br />k Previous Application Made: Yes 171E]No <br />New Construction: Yes ❑ No ❑ fHA/VA: Yes ❑ No El <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank er cesspool permitted if publip sewer is available within 200 feeett) ) <br />' <br />istance from foundation___ Ca ecit ! <br />Septic ank: Distance from nearest well 0 ....-__Liquid idepth._. _._-___-•.---------- P Y <br />�- Si , e--------�:/ <br />No. of compartments ....... .........f------ �� __ istance #o nearest lot li e�� � <br />istance from foundation <br />Dispose ie}d; Distance from ares# w I +� Width of trench...._.r---- <br />Number of linea_"_._-,-,.�•--• -�-- yyh�ength of each line_._: �.• <br />a FF�.Uepth of filter material_". -._.I. .. {� ---_Total length-------1-�/ <br />Type of filter maters ' <br />Seepage Pit: <br />Distance to nearest well_____________________Distance from foundation _._.__._._.____.•.-.Distance to nearest lot line ----_---------- <br />Seepage <br />...--_-•-.� -- � <br />❑ Number of pits•_____ -------•--------Lining material_______________• ----•-_Size: Diameter ------------- -•- • <br />Distance fi•om nearest well __________------- Distance from foundation--------------------. Liquid Capacity ._..._...___... _..__..... gals. <br />Cesspool: "De Depth - <br />❑ Size: Diameter--------------•-•----- ....__....._ p Ing <br />Distance from nearest well---.` -•--•---•-- ---_Distance from nearest buildi-------••------•- <br />' Privy: ...•----- -_------••----_................ <br />F-1 Distance to nearest lot ine-------- __________ <br />---•---•-•-•"-- ----•--------••----•••- <br />Remodeling and/or repairing (describe):.---------------•--. ------ _-. --- :---------- •••-------•---- ---------.... .. ........ . ...... ..••----------• _._._..... <br />-------------------------------- ------------- ------ ared this a f lication and that the work will be done in accordance with San Joaquin County <br />I hereby certify that I have prep pP <br />gul tions of the San Joaquin Local Health District. <br />ordinances, State laws, and rules and re <br />------------ I --- ------ (Owner and/or Contractor) <br />� ,/ � --...._ <br />(Signed) - - 0- . Tale <br />(Plot plan, showing size,of lot, location of system in relation to wells, buildings, eta, can be place on reverse si e. <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY ---•.------. •-•-- DATE' <br />•----- DATE_... ..._-- <br />F REVIEWED [3Y. :... . ....------••-- ---------------• -- <br />+ / _ DATE ----•- <br />BUILDING PERMIT ISSUED n s------------------- ----••-----•----------- --- ---- --... •_...._ .. ................ - - - •--_... ... <br />Alterations and/ recommendations_____________---•--•--- - ...... <br />.._.• ..._._ . .. <br />--•-•- <br />----------- ------ a''yl° ..----/---•----•---.......................... •...._.......__..... <br />ate........ ---- --------------- -- -------- ----- ------------------------------- <br />FINAL <br />---••------•----.-•-__.FINAL INSPECTIONBY: ------ ------ `--- <br />............... ------------------ <br />SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North •'C' street <br />300 well Oak Street Tracy, California <br />l3o South American Street Lodi California Manteca, California <br />Stockton California (/ % /eC <br />I' ,[ 3 /Y✓' 6 �'�^-� t <br />F .-9 tit..«.( •,.. �ro a aF•f i �/ <br />ES -9-2M Peviseo A.7 .P.CO. A f <br />