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FOR OFFICE USE: <br />--------------------- ------------------ ­�------------ <br /> ______________ ______________________________________ _ -�• <br /> APPLICATJON FOR`SANITATION PERMIT Permit No. .------ <br /> J <br />-------- -- _ __ (Complete in Duplicate) Date Issued , !. 5 <br /> :. _ <br />��g ./tet e� f +✓, � <br /> 'This Permit Expires 1 Year From Date Issued <br /> - 71�1U 2-�S -C�S'�1^ �3 <br /> � _ <br /> Application is hereby made to the San Joaquin Local Health Distra`ct for a permit to construct and-install-the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> Ulf -SIDE �scpL-0 <br /> REt-0TT�4 f <br /> JOB ADDRESS AND LOCATION__________________________________ <br /> p -�_n = <br /> Owner's Name-----------------�1�r `i>------------P; T - ------- ---------- <br /> ----------------- -- Phone-.---------------------•----------- <br /> Address 1 �� r�rW.� 20R�------•--- <br /> ------------------------ <br /> •---- <br /> --•----------------------- <br /> Contractor's'Name:= --------Q ------------------------------------------------------------ Phone.. <br /> ------------------ <br /> lnstallatlon will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court'❑ Motel ❑ Other ,E] <br /> Number of living units: _------Number of bedrooms _tip]__-_ Number of baths J----- Lot size ______ ------------------- <br /> Water Supply: Public system F1Community system ❑ Private Depth to Water Table ------r_ <br /> Character of soil to a depth of 3 feet: Sand T--' Gravel"❑, Sandy Loam El, Clay Loam El Clay ❑ Adobe❑ Hardpan ❑' `€ <br /> Previous Application Made: {if yes;date_______ ____ __ __ ) No New Construction: Yes [ o ❑ FHA/VA: Yes El No <br />,� r-K_ x __. =a•• ,_'-._._.� ..� ...- i s _ a., y .' ... �. �_� .... ...w'_.�._..'-1�-'rG"°"-_�s.�...-r�.��•+�..�.s���s..�..*r_.-�::—:n T ry'�'� '�...i� <br /> .TYPE OF INSTALLATION AND SPECIFICATIONS <br /> (No septic tank or cesspool permitted if public sewer is available.within 200 feet.) <br /> Se tic Tank:-` Distance from nearest well___ _____Distance from foundation---/0_-______-Materi I___-. R-F-T- - ------ <br /> p� 1 �� <br /> No. of compartments-----r----- ----- ----Size--�X- ---�---�------Liquid depth------ - -------- <br /> --------------- <br /> stance <br /> - Capacity--f7—GCS_-- <br /> x 1?1 <br /> _-Distance #o nearest lot line <br /> r _____ --- - <br /> Disposal•Field: Distance from nearest well_�Q--.-:_Distance.frorn foundation_ -. • <br /> '. ____--- ----- <br /> Length of each lineIM "3-1 of trench----- E=- y--- � <br /> Number of lines_____._--- 9 ' E r� <br /> - --Total len th-------- f o---------------- <br /> CIP <br /> Type of filter mater€aL__��-�-�---Depth of filterYmater€al`-_I_ __��____ '- g N <br /> Seepage Pit: Distance to nearest well-_______________------Distance from foundation______-____r--------Distance to nearest loft line__.__---__-____-_ <br /> Number of pits_____________________Lining material___- __-___ __-------Si e: Diameter_-_-__..___:__----. Depth C, <br /> ❑ <br /> Dii s' stance from foundation____________________Linin <br /> g material_-.-______________.-________-___-_._.3 <br /> t -- gals <br /> '_--- {-:�` Li uid Ca acit 9 <br /> Cesspool: SDZea Diameter nce from nearest wel------------------Depth---•--------- - ----- q p Y - <br /> ;Privy: Distance from nearest well------------------------ -- -------- ----k--*D[stance fro <br /> building-:-----------------------------=---- - ` <br /> s. . k ________________ <br /> El Distance to nearest lot line__.-__._._____________________ ____ _ , <br /> . ________________ y <br /> k Remodeling and/or repairing (describe)--------------- ------------ €----•------------------ ----------------{---------- ___-___._._______-_____ ______________ <br /> sY <br /> k --------------------------------------------------- <br /> ----------------------------- <br /> ------------------------- ----- <br /> - ----------------------------------;.-----------= . :_-_ _ = =_ = = - <br /> I"hereby certify that I have prepared this application and that the work will be done in accordance with.5an Joaquin County <br /> "T ordinances; State Paws, and rules and regulations 'of-the San Joaquin Local Health District. <br /> I (Signed} -- --- --- -------- '----- -- -=-- (Owner an or Contractor] <br /> (Plot plan, showing size of lot, location of system yin relation to wells, buildings, etc., can be placed on reverse side): <br /> FOR DEPARTMENT USE ONLY, <br /> - DATE' { � 5 <br /> APPLICATION ACCEPTED BY- -%-----l---t-. _ rC� ----------------- --------------------------- ---- --- <br /> = DATE...... - -= ---------- <br /> BUILDING PERMIT ISSUED-------------------------------------- <br /> --------------= ATE ' <br /> REVIEWED BY------ ----------------------------- --=- -----------------f----- -------------------- <br /> D <br /> s <br /> Alterations and/or recommend afions:---------- -------- --- •--- ;---- ------ - <br /> f <br /> _. x -------- ----- ------ --- <br /> ----- --- <br /> -' <br /> ---- -------- —-------------- -" <br /> - --- " = <br /> s a <br /> I FINAL INSPECT 1� Date-------------- --- ------ ----- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> t <br /> a <br /> 124 5 cmore Street 205 West 9th Street <br /> j 1601'E.Haxelton Ave. 300 West Oak Street Y, <br /> Stockton,California Lodi,California Mantecc ECalifwnia Tracy,California <br />