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rUKUNrll-t UJt: <br /> --------------------------------------------------------- <br /> ­-- ----------------------- ----E------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. <br /> [Complete in Duplicate) 6 <br /> This Permit Expires 1 Year From Date Issued <br /> Date Issued -_-•-•---•_-- <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is-made,in complianceith County Ordinance No. 549, <br /> JOB-ADDRESS AND LOCATION IYIFJ41_.(�---------�'1F---sj a.. .._ '" <br /> ..._�...__- �'.... � <br /> Owner's Name....- �f�°! R_ :. a/YI .CI�{ <br /> ---- <br /> 14n�'T�c F� <br /> ,.:._::._::LCL.. <br /> Contractor's Name------ --- • - r <br /> Installation will serve: Residence eApartmerif House ®t Comrn�erclal ❑ Trra Jeer Court ❑ /Motes ❑ Other ❑ ' <br /> Number of living units _.I.... Number of bedrooms . Number of baths/�- Lot size .lp,-.>( �C� , <br /> Water Supply: Public system 0 Community system ❑ Private [Depth To Water Table <br /> F Character of soil to a depth of 3 feet: Sand e Gravel ❑ Loam Clay Loam € �~ <br /> 'Sandy ❑.. y ❑ Clay ❑ Adobe❑ Hardpan <br /> Previous Application Made: Ilf yes,date % ---------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑�— \\�� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> No se <br /> �[ <br /> .tic_t�an.k or c_e i200 feet.sppemi ed' _uilicswer -s availablewitir . <br /> Septic ank: Distance from nearest well-`_15 -._-Dis{an e from foundation..-.�p�_...-_-.Material... ._ <br /> Na of compartments P e�...- ---Size- .A-1 X--a75___Liquid de th--•------- .Ca aci alb <br /> P tY � ----- <br /> Dispos Field: Distance from nearest well-_S -.-Distance from foundation...--/O-'IL...-Distance` to nearest lot line---5. _....q_... <br /> Number of fines----------- ---`------�_._Length of each line-----60--'�--V±�?..Width of trench----•- ---__-_-- a <br /> t <br /> -ft <br /> Type of filter material---��-C�t �epth of filter material__....��.._._._-.Total length...............���_.---__--.L___ <br /> Seepage Pit: Distance to nearest well........ .....{-___Distance from foundation____t 4-----. <br /> ,_ _-:- Distance to nearest lot line............ .� <br /> ❑ Number of pits: Lining ma+erial :�..�------__ize iamef'er Depth- [ r <br /> } <br /> ,,.. <br /> Cesspool: Distance from nearest well_-.R_ ._-....._Distance from foundation---------I-I. .._.Lining material..------ t <br /> �� <br /> ElSize: Diameter----I------------------------=----- <br /> Depth--------- V--------------------------------------- <br /> Li uid Ca aci <br /> 9 P tY-- -•----------------------gals. <br /> Priv i Fl <br /> Y Distance from nearest well..-_....___.......................... ...._-- Distance fro dearest building-......-_._.-_..__. t <br /> ❑ Distance to nearest lot line.-_----------------------------------�_l . <br /> Remodeling and/or repairing,(describe):-------------------- <br /> ,,,� 1 ---------� ------------------- <br /> --- <br /> I ------------------------------------------ <br /> ----- - <br /> -- <br /> ----------------------------------------------------- a,€ ---------- •-- I <br /> --------------�O � - -----------------------------------------------------,- ------ <br /> - x <br /> hereby certify that I haver prepared this applies+ion and +hat the work will be does in accordance with San Joaquin County <br /> ordinances, State laws, and rules and 'regulations of the San Joaquin,Local Health Disfrict. <br /> (Signed)_ �-------••----•-•- ,! <br /> ----- --._..{Owner and/or Contractor) <br /> = ----- <br /> r+ <br /> [Plot plan, show' size of lot, location`o sys+emin`reletion to wells,` uildings, etc., can bfacd-ori�eve�se side): f <br /> �.. <br /> FOR DEPARTMENT USE ONLY [ <br /> . � t <br /> APPLICATION ACCEPTED BY-. f.- .. ._ <br /> --�� ��,.- --------------- ------- --------•--------------------------•--- DATE-.- - /G�----�- ---`:��'':------•-- ' <br /> REVIEWED BY { <br /> - ------------------------------------- - - -------- --- DATE--- ----- k <br /> x....�. .�_..aw........._ .. <br /> BUILDING PERMIT'�ISSUED------------•------=----• •------ ,•.�-.,...w,-�.--_..•....:._ .��_..,,,...�_...�.�.�.=�._._ -. -•------ <br /> F --------------------------------- ---- DAT <br /> 7 ... . ,.,.. ,.-.a,...,..... . ti <br /> Alterations and ,ot recommendations: + �e. - y '% <br /> Z =G -- S � . .1 - ' �� --�_.------ 7 - '.---------••----------- ---- <br /> ------.. <br /> --------------------------••--------------------------•------------•--- <br /> ------------- ------------------------- ------ ----- - <br /> � t. -----------­------------- <br /> FINAL <br /> - - • ----------•------ <br /> FINAL INSP� r�� <br /> - - UADate--- `SI <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street '1300 West Oak Street 124 Sycamore Streeti <br /> 205 Wast 9th Street <br /> Stockton,California Locil-California Manteca,California <br /> Tracy,California <br /> ES 9 REVISES 8-59 ZM 5-6$ ATLAS <br />