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FOR OFFICE SE- <br /> Permit No- ----- <br /> -- -- ------ <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) Date issued ---- <br /> ------------------- <br /> _f This Permit Expires 1 Year From Date Issued <br /> ---------------- <br /> - t <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> rThis application is made1n complian6e with County Ordinance No. 549. <br /> --------------------- <br /> IZ// <br /> ---I---------­----------- <br /> ----------------------- <br /> JOB A' DDRESS AND LOCATru:0:x <br /> Phone- ----V------I--- <br /> ----------- <br /> Owner's __ - _--------------- ----------- <br /> - I -----I--------------I----------------------------------------------------------------------- <br /> ---------- -------- _:----------------I--------------- <br /> Address--.--_- <br /> ----- Ph <br /> -------------------------- ---------------------------------------- <br /> ne <br /> - - --------- <br /> Contractor's Name--------------------------:? House 0 Commercial 0 Trailer Court [I •Motel Other 0 <br /> Installation will serve: Residence E] Apartment 4 - ____ Lot size --------------------- <br /> Number of living units : I_ Number of bedrooms ---�__ Number of baths <br /> f C_ <br /> �ommu;ity system E] Private Depth to Water Table.549 ft."' <br /> Water Supply: Public system El I X . " "--�?" <br /> x 1 .1 Gravel El Sandy Loam ❑C) Clay Loam El Clay ❑ Adobe g Hardpan 0 <br /> e %Y 3 feet. ,Sand C3 <br /> !a - Yes E] No 0 <br /> Charactbr of soil to a !l -- - -, y FHA/VA. <br /> 1,(If,yes',d6t":e P-1.753-1 No ❑ <br /> New Construction: es <br /> e <br /> Previous Application ME: ' I. <br /> " <br /> .- t I el�' SPECIFICATIONS:'�AND S <br /> TYPE OF INSTALLATIONi. <br /> I available within 200 feet.) <br /> (No septic tank or cesspool_permitted if.public sewer is ................ <br /> JX esf wej�-----------------Distance from foundation-------------------Material----------------------------- <br /> p is T Distance from��earCapacity---------------------- <br /> --Size----------------------------m...Liquid depth_--------------- -------- <br /> N0. of compartments-----_--------_----------------- 4 <br /> p ........... <br /> Distance from foundation----------------"-_.Distance to nearest lot line.. <br /> 0 1 Field: Dist�n'ce from nearest well------------------ ------- - <br /> Number of lines-----------------------------------Length of each line-------------------•----------Width of trench---------------------------- <br /> ----Depth of filter material----- --------------Total length---------------------------- ------- <br /> Type of filter material----------------`--oLi . ...... — I I — . - -7 L <br /> D' t ce to nearest lot line <br /> f di ? earest lot line- <br /> '--Distari aflorka <br /> epa Size: Diameter .... Depth....... ------ <br /> Z_-Lining <br /> nearest well-/ <br /> it: \Distance to neare ---------- c ---- --------- <br /> Size: <br /> of pits----- material� - <br /> r foundation__--P-- Lining material--------------I----------------------- <br /> r'e 7 ' I <br /> Cesspool: bistance fro`m�nea 'sf well-----------------Distance from ca�aci -gals. <br /> -------------------- <br /> --- --------Liquid <br /> ❑ .Size: Diameter----- ------------------------------Depth--------------------------- ------ I -- I <br /> i - --------------- - <br /> Distance from nearest builcling___-�---------------- ........*t <br /> Distance fron�' n'earest well--_--.-."---_- -1--------------------------- ------------ <br /> Privy: I_ -------------------i------ u-----"---------.- <br /> ❑ Distance to nearest lot line.--------------a----------- ----- ------ <br /> --------- <br /> - <br /> ----------------------------I----------------------­---------•---------I-------------------------------- ----------- <br /> Remodeling and/or repairing (describe):----------- ------------------------------------------------------------------------ <br /> --------------I------------------------------------------------------- -- <br /> .---------•-•---•--------------------- ----------------------------------------------------------- <br /> ----------IL-------------------I---------------------------------------- ----------------- --------------------- -------------------------- <br /> ----------------------------I------------------ ------------------------------------------------ ------------------------------------------------------­1-------- <br /> -------------------------------------------------------- ---------------------- k will be done in accordance with San Joaquin County <br /> I I-hereby C that I prepared this application and that the work Health bistrict. <br /> -here : g:ulations of the San Joaquin Local He <br /> y t I s: and rules and ordinances a . a 11� wher and/or Contract <br /> --------------------------- <br /> --------- <br /> 5i ned;.cl)_.----- ----- - - - ---------- --------- ----- - -------- <br /> -------------------- <br /> ATitle)----Led, 7----------------------- --- <br /> By:--------------------------------- ------------ -- --- -- ------- <br /> Ce e in rel n to wells, buildings, etc., can 69 placid " r6verse side). <br /> I _?n <br /> (Plot plan, showing-size of lot.- 10 ion of Sy!+ M <br /> FOR DEPARTMENT USE ONLY <br /> DATE ------------------------------- <br /> APPLICATION ACCEPTED BY. ' ------ ----------------------------------- ------------------ -------- --��A <br /> REVIEWED BY------------------------------- ------------------------------------------------------------------------------------------------ DATE---------------- ----------------------------------------- <br /> I DATE------------------------------------------------------------- <br /> ------ ---------------------------­--; I V <br /> .. ....... ------------------------ <br /> BUILDING PERMIT ISSUED-------------------------------------------------- . ..... ------ <br /> Alterations and/or recomm`endations-__1;_.-1 <br /> ----------L5---- <br /> --------------------------------------------------------------:­----------------------------- ------------------------------------------- ---------------------------- ------------------- <br /> ------------------------------- ------------------------- --------------------------- --- ------------ ----------------------------------------------­.- <br /> ----------------------------------------------------------- -----------------I-------- <br /> -------------r--------------------------- ------ <br /> ---------------------- <br /> -------------- --------------------------------------- - -7----- ----------------------------------------------------------6_-------------------------- <br /> k _ --------------------------------- --------- 7 <br /> ---------------- -- ------------------------------- <br /> Date_ (e-------- ------ - <br /> -------------------------- <br /> ------------- -- - <br /> FINAL INSPECTION BY:__C"IV ------ <br /> ------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 205 West 91h Street <br /> 130 South American Street 300 West Oak Street 124 sycamore Street <br /> Lodi,California Manteca,California Tracy,California <br /> Stockton,California <br /> REVIBEO 0.59 F-P-Co'2M 6'60 <br />