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B 20 <br /> Lv <br /> --------- <br /> --------- �_._.---p��T <br /> . 1 s <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------- ---------------- -------------------------------- — P Date Issued <br /> to in Duplicate) / <br /> ---------- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and insfall the work herein described. <br /> This application is.made in.•compliance�vith County Ordinance No. 549. <br /> 3 aJ.. g-ova [/fJ r4�n�: p�(_ —vA <br /> J-2 er{ X ��-, <br /> JOB ADDRESS AND LOCATION___-�`%"6 - _ __ X_ p � � <br /> Owner's Name------------ /- Q <br /> yam- ------------- <br /> Phone------------ <br /> Address----------• <br /> -------------------------------- <br /> i <br /> ---=-------- <br /> Contractor's Name Cd. l_S �` ----------------- ----------------------------------------- Phone <br /> i . <br /> Installation will serve: Residence a/<partment House ❑ Commercial ❑ Trailer Court [] Motel ❑ Other ❑ <br /> Number of living units. _.1-- Number of bedrooms _..T_ Number of baths _ _ Lot size ----Idt- <br /> -•------------ ------ <br /> Water Supply: Public system ommunity system ❑ Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam UV—Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date----------- --------) No ❑ New Construction: Yes EA--No ❑ FHA/VA: Yes ❑ No ❑~` <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> f <br /> Septic Tank: Distance from nearest well-----71--Distance from foundation- ------------ <br /> .Materiaf_.-.---_ 5%-__---- <br /> 1]1— No. of compartments---�---------------Size---Ez _ _ -_-- Liquid de th--, .- .. • <br /> Disposal Field: Distance from nearest well. <br /> ---_�z------Distance from foundation,l _!�_/__.Distance to nearest lot <br /> { Number of lines--_-�__- _-.---Length of each line- '-(raG'-. o---Width of trench.__ _'--_-------------- <br /> Type of filter material- -�',V4/----Depth of filter material__1.,0-'------ __Total length--- _/�4 '-------- <br /> Seepage Pit; Distance to nearest well-----_---------------Distance from foundation_-r�Q__"----.Distance to nearest lot line-_,.--�--.-- <br /> D Number of pits----�------------Lining material-_ // , -.Size: Diameter------- ------ <br /> p ----------------- <br /> i' Cesspool: Distance from nearest well-----------------Distance from foundation-.-_---------------Lining <br /> f t �4° ❑ line---- ----------- - ----_ <br /> mate <br /> riaL---------------------- <br /> k <br /> ---- --------_ --k` El Size: Diameter----- .- <br /> Distance from nearest well-. De th ----------- Liquid Capacity------------------------- gals. <br /> ----------- <br /> ! <br /> fy" <br /> , <br /> l <br /> 'Lx Distance to nearesf lotri ,4 <br /> -- - - -------------------------Distan-ce from nearest building__ <br /> R,&clen9 dorre airin9 describeJ --.-_ am - •- 7------------------------• ; <br /> •-------------------------------- ---------___^ --- ----------------------------- a" <br /> - ! - = , <br /> --------------- <br /> -------------------------------- <br /> ..------------- <br /> --------- --------------- --- ---------------------------------------------------------------------------------------------------------------- ---- -------------------- <br /> f I hereby certify that I have prepared this application and'that-the--work will'be done'in accordance with San Joaquin County <br /> F ordinances, Statela�%s,.rap rules and regulations of the San Joaquin Local Health District. <br /> �-------------------------------------------------- I a d/or Contractor) <br /> By-------------------- -r <br /> -- - - --------r-------- - -- <br /> -� -�----- -- - - � - - ------ ----Tit e)---- '-- <br /> sF�. <br />{ (Plof;;plan, showing size of lot, locafion of em in relation to wells, buildings, etc., can be placed on revere side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ---_-- _--- -------__--_------ DATE6 , <br /> i �-�--- -- - - - -------------- ---- ---��-�-- -------'----------- ------ <br /> REVIEWED BY. - ------- •--- ------- DATE-------- <br /> BUILDING PERMIT ISSUED--__-- _ DATE �-------------------------------------- <br /> f <br /> Alterations and/or recommendations:--__-_---,E�- _ . /_4�...i-_._-._._- roc- Z` _ -_z� �t.�;__!c-w. ��:_ „:,_ <br /> ------- r - f__ %lr� / <br /> .� --------- --•- ��----•�-------------1' ��--�---•-rr�� �z:�� /, . it <br /> - -------------- -- •----------�-=�-•lam'•------- " <br /> ---------------------­---------------- ---------------- -------------------------------------- ------------------------------------------------------------- <br /> - ------ ----------------------- " <br /> s/ � --------------- Dat � � <br /> ------------- ---- ----------•-------- ---------------------------. , <br /> / J ff ��-- <br /> FINAL INSPECTION BY:_.-._- ------------ - - <br /> SAN OAQUIN LOCAL HEALTH DISTRICT <br /> s <br /> 1601 E.Na:ellon Ave. 300 W t Oak Street 124 Sycamore Street <br /> 205 West 9th Street ! <br /> Stockton,Californfa Lo i,California Manteca,California Tracy,California l <br /> F.P.c o. <br /> a <br /> C <br />