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FOR OFFICE USE: <br /> --------------- ------------------ -- ---------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br />------------- <br /> (Complete in Duplicate) <br /> ��... Date Issued _7---= ---------- <br />---..------------------------ .:_---- This`Perrnit"Expires 1'Year'From Date Issued <br /> Application._ais hereby made to the San Joaquin Local Health District for a permit to construct and in—l the work herein described. <br /> This application is mad 61Fi2ompli na ce"wifh-County"OM inance`N6.- 49. <br /> Xol_� <br /> JOB ADDRESS AN LOCAT ----- ---- ------------- - `— ---- -- --- -- f <br /> Owner's Name --_1--------- - ---- ------ Phone_de. -//•-- --�� <br /> - _ [J <br /> Address__ -- - -- ------------------------------- <br /> Contractor's Name --------- _ �T .SI... .......l c------------------------------------ Phone � �G � ' <br /> _ _ I I. r <br /> Installation will serve: Residence l l Apartment House ❑ Commercial 0 Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _1,_ Numb Jr`iof bedrooms.3-__- Number of baths �Lot. seize. _-- J` --�-�pQ-r-------------------------- <br /> Water Supply: Public,system ❑ Community system ❑ Private g Depth to Water Table &S7-ft.Character of soil to a depth of 3 feet:' Sand E] Gravel E] Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> 1 -w,w • <br /> Previous A lication Made :(7If�.yes;date --: -)--INo 54-, New Construction: Yes E]-Nb FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 'r <br /> ` {No-septic'tank`orcesspoof-permitte&if-public-sewer-is available-within 200-feet:]� ` <br /> Septic Tank: Distance from nearest well_________________Distance om foundation__._____.. <br /> ---------------"----.Material.................. ---------------------------- <br /> ❑g;''�E"5#0JC- No. of comp irtments--------- --- -----------Size--`---------f--- :�----- ----Liquid depth-------A-----------------Capacity----------------------- <br /> I <br /> ---- --------- <br /> D'+sposa4 Field: Distance f bm 1earest wel � -.._Distance from;foundation___SO-- __.FDistance to nearest lot line-J.E __.__. <br /> INumber ofllin es-- C- -"-' --Length of line---40-.-- �r -- -Wdth of trench--- - ---•------------------ <br /> T e of #il.ter,_material _y.___.__ -__.-. Depf� offilter`m" aferi_l___L-�----------Total length---._ 0---_______________.______ <br /> E ---------- <br /> Type � � J <br /> Seepage Pit: Distance to nearest well_. �__._______Distance m fo" dation__� __.____.Dlstance to nearest lot <br /> Number of pits _ Cl tLiriin material..__f�-_.__�. ... -Size: 4+a+�rre+e�r_ kgxl.9.Depth--------------------------------- <br /> Cesspool: Distance fr ',.nealest�"well_ _'*_ _t___Distance from foundation___-----------------Li ng material____..-._..._..____-._--.-_.----__--- <br /> PK ,- 9 <br /> k . <br /> ❑ Size: Diameter-._- - "-`------------ �::----Depth---------------------------------------------$ Liquid Capacity------------------ 9als. <br /> $` f .� _.....__._Distance from nearest buildin �C <br /> Privy: Distance from nearest well---.-- ------------------- 9--- ---------- 1 <br /> _ <br /> ❑ Distance io n.earest lot-line-------- ------------------------ - -- ---------------------------------------------­---------------------------- --------- --------- <br /> Remodeling and/or repairing{describe): + ----- ------ A- <br /> -------------------------------------- <br /> _ <br /> --------------------------------- -------- <br /> �f - ` #`!! �...,..' �„ .. ----�,."�----------- --=- ---------------- - ----------------------------------- <br /> y Y -„ p -� - .._ .. ------ _i- ---------------- , <br /> I hereby certify that I have repared the pplication;and that the work will, be doneIn accordance with San Joaquin County <br /> ordinances, State laws; and rules;afld reg i tt ns of+he Sa oaquin local alehl]is#rict. .gyp <br /> --------- - -- --- -- `----- -Owner and/or Contractor) . <br /> (Signed)------------------- <br /> -------- <br /> -- --- _ <br /> r -- ----- ,_ _ `.- .�.• Tit1e'"� T ` --------- <br /> - <br /> - --- --- ---------------- � � { ] <br /> (Plot plan, showing size of to , loation of system in relafion to ells, buildings, etc., can be place n reverse side). <br /> 1 FOR DEPARTMENT USE ONLY <br /> # ., ` C r /- DATE- --------- <br /> --------------------- <br /> APPLICATION ACCEPTED BY_.._�-----f------ ------------------�=`-!------ems_"� { <br /> REVIEWEDBY------- ---------- - -- -------- ----------- ------------------------------------- DATE_------- . . --- ----------------= ------------ <br /> BUILDINGPERMIT ISSUED---------------•----------------------------------------------------------------------------- ..-- DATE--- ------------------------------ ----------- ------------- <br /> Alterationsand/or recommendations----------- ---- --------------------------------------------•----------•-----------------------------------------------------------------••------------------- <br /> If - ----•--------- ---------- ------------_- <br /> --------------------------------- ---------------------- ------------------------------------------------------------------------------------------- <br /> f ------------------------------------------------------------------------------------------ - -------------------------------- <br /> I --------- ---------------- -------------------- --------------------------- ---------------------- ---------------•--- <br /> f <br /> FINAL INSPECTION BY:- ---------- Date---?-+-_�.__/--Y ` ---------- ------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />