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rvtc Urrlc,t USE: �- <br /> ---- <br /> --------- ------- --- <br /> -------------- -------------------------------.______.. APPLICATION FOR SANITATION PERMIT Permit No. <br /> --------:•-------------------- (Complete in Duplicate) <br /> - This Permit Ex fres 1 Year From Date Issued Date Issued ....-__,f a__6 Z. <br /> Application is hereby made to the Sen Joaquin Local Health District for a permit to construct and install th work <br /> �ein described. <br /> This application is made in compliance with County Ordinance No. 549. he <br /> ANKH <br /> JOB ADDRESS AND OCATION_-•------_-- --•(- 11� b. _ �o 1r OF, OA1 f0M �Q . t)j DF_ <br /> T •---• <br /> ---5 earua� r� i 5 <br /> '�- :_-•� � 1 l [ .. w.s.�-_----------- - --- Ph net�ft�� �t <br /> Address.. RIE <br /> ----- `�'.......& <br /> 11If1r71�.T -- ------------- •-•--•---------- <br /> Contractor's Name,------©-]�111(i f <br /> --- -�_.- ------------------------ Phone------.................... <br /> •-•------ _ _ <br /> Installation will serve: Residence Apartment House E] Commercial E] Trailer Court [] Motel ❑ Other ❑ I; I <br /> Number of living units: I.___ Number of bedrooms _;3-- Number of baths I_ Lot size <br /> ---•----------------------" <br /> Water Supply: Publics stem <br /> y ❑ Community system ❑ Private Depth to Water Table � ft. <br /> Character of soil to a depth of 3 fee+: Sand Er' Gravel ❑ Sand Loam y ❑ y ❑ Adobe❑ Hardpan ❑ <br /> Sandy �' Clay Loam Clay � <br /> Previous�Application Made: (If yes,date____________________) No [ New Construction: Yes 2"—No ❑ FHANA: Yes ❑ No <br /> TYPE OF INST—RATION AND SPECIFICATIONS: l <br /> (No sepfic tank or sspool_,permitted if public sewer.is.available within.200,feet.) <br /> i .T.... ..-... <br /> P P Size:::. _� ation ... _..Material__ DI C <br /> Septic Tank: No. of com artmenfs- well ___��- Distance e from foundation-' <br /> ound Liquid depth__.._ Capacity—/ � <br /> ' r �,ti. ----- . <br /> Disposal Field: Distance from nearest well_.,-0--- D'r's cefroinfdundation___. <br /> .ill..... Distance to nearest lot line...... <br /> Number of lines---_ y-�---------------Length of each line_-___qQ- -k• <br /> ----Width of trench------ <br /> Type of filter aterial._ Ct_ / -----•Depth of filter material__PJS......)--Total length_..........;F <br /> ------•----------•- <br /> Seepage Pit: Distance to nearest well ---- --_ <br /> s Li s--_ .. F:. . S tion ;_: -_ _.Dis#ance to nearest lot line_____________ <br /> ❑ Number of pit's----- ----••----------Lining materiialGe__f-�-- foundaze:�Diameter--- •-------•--Dept h------••----•------------- <br /> i�li <br /> Cesspool: Distance from nearest well.___._____-----Distance from foundation---_------------- Lining material.____.._.....____..____...__..__.___. <br /> s' <br /> ❑ <br /> Size: Dame#er---- --- ------------------------.Depth---------------------- r"t-------Aiquid Capacity ._.gals. <br /> Priv I .e �----- ----------- � .. g <br /> Privy: Distance from nearest well___________ ----------------------------- ----- fro nee�rest building •-----•-----• ------------- •---- <br /> ❑ Distance to nearest lot line--------- �'4 _- dt ... 41i'+f <br /> I ----•------------- <br /> Remo eling and/or repairing (describe):-4------- _______ ------------ <br /> --------- <br /> _______ <br /> _. __.____---__________________________________---__---__---___,:-- _m!----------------------.___.___-_-____-_•.____I...... <br /> _TF <br /> k --A----t----- F--F�_-..D.. / aR_ -..__Z/v P_�c17c <br /> f. . --------- , <br /> y prepared this application and .hat the work writ be Boise n a <br /> . ! hereby certify have �M---- / , - � � f C -------- <br /> -75 <br /> •----- -- <br /> accordnnc"wi+h"�San`,l�equin County <br /> ordinances, tate laws, and rule and re ui tions of the San J"nquin Local°`Healfh District. <br /> f` �f`1 r <br /> �` -----•------- --_�-(Owner and/or Contractor) <br /> By:. ------------ <br /> -. --------- ---- --- --•-- _--- - -- - ------ -------------{Title)------------------- ------------------_--- <br /> (Plot plan, showing size of I Io4 9+ion 'of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY`' ._�--y�-"'yr--------------------------------------------------•---------------- DATE----- <br /> REVIEWED BY.------------------- •------- - ---.... <br /> BUILDING PERMIT ISSUED <br /> --------------------------------------------------------•••--- RATE --•--••----• <br /> ---•-• - ----- - -- ----- - ------ *DATEn_, <br /> Alterations and/or recommend'a+ions:___ i <br /> ....__ -----------------------------------------•----•----------._----- <br /> a~s4. <br /> ----- ------------------------------------------•---------------------- -------- _ = <br /> ------------------------------------------,----- ­. <br /> ---•------••------------••-----••............. ... ... .... ...... . rvi R �Priv <br /> - --- ----- <br /> ---- - -------------------- •----•---------- <br /> ---- ----- <br /> ------------• ---------- <br /> FINAL INSPECTIO B -- Date----------- r ------------- <br /> ---------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak street 144 Sycamore Street <br /> 205 Wast 9th Street <br /> Stockton,California Lodi,California Manteca,California <br /> Tracy,California <br /> ES 9 REVISED 8.59 4M 5-951 ATLAB <br />