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FOR OFFICE USE: <br />---------------------- ---------------------------------- APPLICATION FOR.R SANITATION PERMIT Permit No. <br />-------------------------------------------------------- <br />-------------------------------------- --------- --------- (complete in Duplicate) Date lssuecl'/D_/Z//�_tv <br /> ----------- ------.------------------------------ This Permit Exeires I Year From Date Issued <br /> Application is hereby made to the Son Joaquin Local Health District fora permit to construct and install the work herein described <br /> This application is made in compliance with County Ordinance No. 549 aso <br /> JOB ADDRESS AN LOt�ATION_19,Xo�--- ----- - --------- - ----- <br /> - --------------------- --------- --- ------------- --------- ptone----------------------------------- <br /> owner's Name---- <br /> ---------- ------------ <br /> ---------------- ----------------- <br /> ---- ,°Address. -- <br /> Address. <br /> ------j� --- hone..-------------------------------- <br /> -- ----------- <br /> Contractor's Name.-_-_____-- m .. Motel 0 Other Installation will serve: Residence F] Apartment House E] Commercial ❑ Trailer Court <br /> Number of living units: ____/ Number of <br /> ' bedrooms _jl*�NumberFf baths _ ____ Lot size <br /> X_ ---------------------- <br /> Water Supply: Public system [ Community system Eprivate Depth to Water Table __-_____y ft. <br /> h Adobe ze�artan El <br /> Character of soil to a deptof 3 feet: Sand ❑[] Gravel 0 Sandy Loam El y Loam El Noo <br /> Previous Application Made: (if yes,date.______ ----------) No 171 New Construction: Yes E] No ❑ <br /> F1 FHA/VA: Yes El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer isavailable within 200 feet.) <br /> Septic ank: Distance from nearest well---,!5'0-de-Distan e frp;�ounclation-------/0-0__/feet.) ~ <br /> S-(iquid depth------Z/-/....... ---Capacity-----/-=�gtn <br /> ----Si <br /> No. of compartments-----C-=�------------ _4 <br /> lot line-S---------- <br /> Dispos Field: Distance from nearest well-. Distance from foundation___J-0----------Distance to nearest - If <br /> 1001 -------Width of trench--------02----­------------------- - <br /> Number of lines:_______________ - --- ------Length ;f each line_-------------------p . i V <br /> .ni/f7------Depth of filter material____.1-,R-----------Total length-------- ---0-0----------------------- <br /> Type of filter ma I l - �e <br /> 1 Z� e--.! <br /> Seep/ae Frit: Distance to nearest well----/n�_ ____Distance from founda4 ion------A .Distance to nearest lot lint _-______. <br /> Number of pifs--------/------------Lining material_ PW�_,,--Size: Diameter______T4----- ---Depth_.2S------------- ------ <br /> Cesspool; Distance from nearest well--------------_Distance from foundation.____- Lining materiel_______________________.____._--.__-. C <br /> ❑ <br /> aterial-------------------------------------- <br /> 0 Size: Diameter-------------------------------------Depth------------------------------------------- -=------Liquid Capacity- --------------------------gals. <br /> Privy; Distance from nearest well___._.______---- ________________________.__._Distance from nearest building_____________-____________-__.._---._.__. <br /> F1Distance to nearest lot line- ------------------------------------------------------------------------------------------------------------------------ -------- -------- - <br /> Remodeling and/or repairing [describe:------------------------------------ --------------••-----------•-------- r---------------------------------------------------- <br /> -------------------------------------------------------------------------------------------------I------- ------ ------------------------------------------------ -------- ----------------------------------------------------_ <br /> --------------------------------------:----------------------w-------------------- ------------------------------------------------------------------------------------------------------------------------------------------ <br /> ----- ------------------ -------------------------------------------------------------------------------------------------------------------------------- --------------------------------I------------------- --------- <br /> I hereby certify at I ve prepared this application and that the work will be done in accordance with San Joaquin County <br /> S an Joaquin Local Health District. <br /> ordinances, State I s an les and regulations of <br /> (Signed)------- -------- ----------------------------- - ------------ and/or Contractor) <br /> f------ ------ -------------- --- -- -------------------------------------------------- <br /> _,.eBy:------------ ------ -- ------ ------ -------(Title)------ ------------ ..... . . ............... --- --------- <br /> 'a of lot, n Tela on to wells, 6 ings, etc., can be placed on reverse side). <br /> (Plot plan, showing of lot, location o system i r I <br /> FOR DEPARTMENT USE ONLY <br /> - ------- DATE---- 07 <br /> APPLICATIONACCEPTED BY------ -------------------------------- ----------------- -------------------------------------------------- <br /> REVIEWEDBY------------------------ ----- ------------------------------------------- DATE-----------------------------------1 -------------- --------- <br /> ---------- <br /> ----------------------------- -�:-- ------------ <br /> BUILDING PERMIT ISSUED-----------------------------------------------U----------------------------------- - DATE -- <br /> Alterationsand/or recommendations----------------------------------------- ---------------------------------------------------------------------------I------------------------------------ <br /> ----------------------------------------------------------------------------- -------­------------------------------------------------------- ---------------------------------------------I-------------------------------- <br /> ------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------- ---------------------------- <br /> --------------------- ------------------- --------------------­- --------------------- --------------I---------------------------------------------------------_-----------------------------------------­­--------------- <br /> _­­ ----------- ------------------------------------------------- --------- ................ --------------------------------------- -------------- ---------------------- -------------------------- -- <br /> FINAL INSPECTION BY,;:,'�r-- ------ --------I/ ------------------------ ------------------------------------------ <br /> ------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Mf N Stockton,California Lodi,California Manteca,California Tracy,California <br /> REVISED 8-59 3M 3-'63 F,P.CU. <br />