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FOR OFFICE US . F <br /> 4-4- ------ <br /> APPLICATIOW FOR SANITATION PERMIT Permit No. ........................ <br />-- - ------------------ -------------------- ------------ <br />--------------------------------------------------------- I (Complete in Duplicate) 6.L, <br /> Date Issued <br /> ------------------------------- ------------ This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein descried. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOBADDRESS AND LOCATION----- ------------:_ 3k------ ......... ----------------------------------------------------------------------*---------- <br /> Owner's Name--------------=-=T=---------- 7P-- <br /> ....... -X-� A--,:-------- -------------------------------------------------- Phone.A-Y=­ `,Y-Z.7 <br /> --------------------------------------------------------------------------------- <br /> Address------- ------- i,�............. <br /> - 1-5o"D- ----- ----m---•------- <br /> Contracfor's Name - -- --- -- - - 5k Phone---------------------------------- <br /> ----- - ------ -------------- -----------I------------------- <br /> Installation will serve: Residence ®!Apartment House El Commercial E] Trailer Court C] Motel [] Other 10 Zx-m.4"�r.,,Z <br /> f - y 5 " - <br /> Number of living t-units: Z---- Number of bedrooms Number of baths -b2.. Lot size / -V,x- /--d----o---- <br /> " <br /> Water Supply. PubliF, system X Community system El Private F] Depth to Water Table y.+ --- it. <br /> Character of soil to a depth of 3 feet: 'Sand L] Gravel [] Sandy Loam [] Clay Loam 0 Clay [j Adobe Hardpan F <br /> New Construction: Yes IN No [I FHA/VA: Yes E] No 9 <br /> Previous Application'Made: (if yes,4.,te'.,,- e_ Nog <br /> "o <br /> TYPE OF INSTALLATION AND"SPECIFICATIONS- <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> a M <br /> Septic Tank- Distance from nearest well_____*-------Distance i from foundation-------ZO-------- aterial--------------------------------------------- <br /> co`mpartm;nts-----------aZ----------Size----- Liquid depth-...-.------ ----Ca pacify---2-0-0 <br /> 0 rest well ---Distance to nearest lot line_______.„.._ <br /> D;sposal Field: Di�t8n6e from,nearest ---------+..-.Disfanqe from foundation... ---- <br /> engfh of each line------------410.1----.Width of trench--------- 2Z------------------ <br /> 0 Number ofjin6�--2-------------/---------------Length gth-------------*'�-/ <br /> 6 10 Type of Depth" of filter material---------/ff-------.Total len -------------------- <br /> 1, � — , ". q , -14 . I � <br /> Seepage Pit: Distance to ne'arest,well----------------�----Distanco'from foundation--------------------Distance. to nearest lot line__.-________.--- 1J" <br /> ❑ Number <br /> ine------------­--- <br /> Number of='piisz�--,!-------------Lining maferial---------- ------------Size: Diameter---------------- --------Depth--------------------------------- <br /> Cesspool: Distance iro(n nearest well------------- Distance from folundafion------L----------- Lining material____---____________________--_-_____.-- <br /> ElSize: Diameter--------- -------------------- -------Depth---------------------------------------------------Liquid Capacity---------------------------gals. <br /> I from neardtf"15611cling------------- ------------- <br /> --- -------------- <br /> Privy- Distance �r6m�nearest well---------------________---------- ----------- -.D1 <br /> F-1 Distance to near'e-'st'lot ----------------------------------------------------------=•­--­------------------- ------------------------------------------------ <br /> Remodeling and/or repairing (des ibe -------------------- ----------------------::...... ----------------------------- <br /> i---- ------ <br /> Lrl� -,--------•;;---- <br /> --- <br /> -----------­-­-------------------- ti� <br /> -------------------- ------------------------------------ ------------------- <br /> -­ ------------------I------- <br /> ------------- ------ ..... ----------:­- <br /> ------------------- ------------------------------ ------1--------------­-- <br /> --------------------------------------------------------- <br /> j------------------- ------------------------ <br /> ------------w��------------------ <br /> ------------------------------------------------------•---------Z --------------------------------------------- ----------------------- - -i' <br /> I hereby certify that I have prepared this appli <1 be"done i6-'accordance.with San Joaquin County <br /> cation and that the work will, <br /> ordinances, State laws,kand rules and ulations of the San Joaquin Local Health District..' <br /> ----- -----------I-------------------------------------- -------::�------------------------(Owner and/or Contractor) <br /> (Signed)----- <br /> i <br /> -----------{Title)----------------------------------------- - ------------------ <br /> By:-------------- - -------­----------------------------------------------------------------------------------------- <br /> - <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEP RTK <br /> ��NT USE ONLY <br /> -,If 17 <br /> ------------------ <br /> APPLICATION ACCEPTED BY--------I--- ----- ------- -- ---—------- <br /> III <br /> REVIEWEDBY------------------------------------ -------------- -- - ----•----------------------------- ------------------------­­ DATE--------------------------------------------- -------------- <br /> �- i�. ,­ " -i ----- ,------ DATE. ­------ -- <br /> BUILDING PERMIT ISSUED------------------------------------ ---------------- ---------------­- ­6 <br /> Alterations and/or - ---- -- -- -- ---- ......V. ---------- ---------­-- -------•--------.----- <br /> --- <br /> --------------- <br /> ------- <br /> ---------------... .. ­.-------- <br /> ....... ------- <br /> -tl-W- - --p4ag <br /> MAE IN IECTIO BY:- ------------------ <br /> --- - ­ ----- ..... <br /> ------Z44--t S77 o <br /> 4- <br /> Date-- - ------------------------ <br /> ­�)­ ------------------- .5:- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street `.joo iles't Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California 'iocli,Co'lifornia Manteca,California Tracy,California <br /> E9-9 pEyiorb G-59 F.P.00.2M 6-60 <br />