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FOR OFFICE U8E: <br /> - ------------------------------------- - <br /> ---------------- <br /> ------------------------------------ ----------------- APPLICATION FOR SANITATION PER-MIT Permit No. <br /> (Complete in Duplicate) <br /> Date Issued <br /> ------------- . ....... This Permit Expires I Year From Date Issued -0 <br /> 2-091- Is -"C,> <br /> Application is hereby made to fho-San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in complien'e with County Ordinance No. 549. t <br /> /OTC-. <br /> A------E.------(�-�r->---_..-_- r <br /> __or--------Av-sm-w-------------------------------- <br /> Owner's Name-------------------- ----------- ------------ -------------------------------------------- Phone------------------------------ <br />'' Address------------- <br /> Uk-------3 -.4 ------------------------------------------------- --------- <br /> VV - � - _f -. -------- ------------------- <br /> Contractor s Name-------Pwwa;�K <br /> ----------------------I------------------------------------­---------------------------------. Phone_.,------------------------------ <br /> Installation will serve: Residence! <br /> I.,E] Apartment House 1-1 Commercial El Trailer Court. F1 / <br /> 1 Motel 0 Other E] <br /> Number of living units- - ____ Number of bedrooms 3--_ Number of baths 3--- Lot size --_/ 0-------)K___.137-_______________________ <br /> Water Supply: Public system 5❑ <br /> '111 Community system E] Private RT' Depth to Water Tab). 5'_ ft. <br /> Character of soil to a depth of 3 feet: Sand e Gravel E] Sandy Loam E] Clay Loam E] Clay ❑ Adobe-[] Hardpan E] <br /> Previous Application Made: (If yes,date--------------- ----) No We New Construcfion: Yes 2"No El FHA/VA: Yes E] No 2— <br /> _TYPE_j,0F�j NSTALLATIQ Nti AND-SPECIFICATIONS:= m, - i <br /> (No septic tank or cesspool permitted if-public sewer is available within 200 feet.) <br /> Septic Tank: D�stance from n�aresf we� ,'0_ Disfancefrom founclat!ion__A9-----:77�af - I C991VIC-R9xe� <br /> eria —--------------- <br /> No. of.c nts-.------ ........Si, Ca­p -wy <br /> _!�mpartmie a /Za6? <br /> t. IL <br /> Disposal Field: Distance froM,a,ne,a,ro-if �ve�17S_ -..-Distance from foundation--;./ ---t_-Wan��to_nearest lot'.liae-----4�------- <br /> .Ft4-- Number of lines___. G!s, Length of each line2_246.10!f....... 70------Wicifk4ti -------- <br /> ___kDepth of filter material----_'~----- _Total- length_______---------#66B 1��_! <br /> Type of filter,--materia], .7. <br /> //0 <br /> Seepage Pit: Distance to nearest well_..___-- -------------Distance from foundation---__----_______-- Distance fo nearest lot jine----------------- <br /> El Number of. pits...1------------------11-ining material--_--------------------S-I!Ze: Diameter_,-------------------Depth----------I_--------------------- <br /> Cesspool: Distance from nearest well- _ Distance from found'aifion__ Lining material___----------------------------- <br /> Iii <br /> El Size: Mam'eter-------------- __1------- __.Depth------_------------j--------------...............Liquid Capacity---------I-#------I--------gals. <br /> Privy: Distance from nearest well_ /Distance from nearest building---------------s-------------------------- <br /> ---------------------------------------- -- <br /> w. <br /> 0 <br /> 0 Distance f nearest lot line .------------------------------------------ <br /> _;XRemodeling and/or repairing (describe]:____---- ------------ ---------I------ a <br /> 1.& <br /> --------------------------------------------- ----------------------------------------------- -------------------- <br /> --------------------------------------------------------------------------------- --------- <br /> ----------------------------------- --------- ----------------------------------------- ------------------------------------------------ ----------------------------------------------------------------- <br /> ---------------------- ---------------------- ----------------------------------------------°"-------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------- <br /> I hereby certify that I have prepared This application and that the work will be done in accordance with San Joaquin County <br /> ordinance;rSte, laws, and rules and. regul.ationf of the San Joaquin Local Health District. <br /> {Signed]--- --------------- ------ <br /> -------- -- ----------------- <br /> ----------------------- -------(Owner and/or Contractor) <br /> --------- - ------ <br /> Y. <br /> ---------------------------------------------------------------------------------------------------------------------------------{Title].'`. _ ------------------------ -------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed an reverse sided <br /> . 'i <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------- - --------------------------------------- DATE------- <br /> REVIEWED BY----------------------- <br /> I------------------- -- ----- -------------------------------------------------------------------------- DATE----------- <br /> BUILDINGPERMIT ISSUED------------------------------------ ----------------------------------------------I------------------ DATE------------------------------ ---- - -------------------- <br /> Alteration's and/orebcommericlafio t":'.____ ----—-------­.— <br /> - <br /> -------------- ------------------------------------ -------------------------- -------­-------- ---------------- <br /> -------------------- ------------•--------------- ------- ----------- <br /> ----------------------- ------------------------------------------------------------------------------ <br /> ---------------------------------------- ------------------------------- ------- --- ------------------------------------------------------------------------------------------------ ........ --------------- <br /> ------------------------------------ -------------------- ---- .... <br /> ----------------Q.Q.-- Date---- --------// <br /> ------------ <br /> ------------------ --- ----------------------------------- ------------- -------------------------- <br /> FINAL INS <br /> ----------------------- ­ -------- ------ - ----------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California k Lodi,California Manteca,California Tracy,California <br /> F.P.0O3 <br />