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FOR OFFICE USE: <br />------------ ------------------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. 7 <br />-------------------------------------------------------- - _ . _ _ <br />------------------------- <br /> -------------------------------- (Complete in Duplicate) `" ; <br /> I Issued Date I;sued .- - <br /> This Permit Expires 1 Year from n Date 2-3 -5—wo- Z-a <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descrv/ <br /> This application is made in compliance with County Ordinance No. 549. j <br /> AV ' <br /> ---------------- <br /> - 15 --------------- ---- ----------- <br /> I---------- <br /> JOB ADDRESSAND LOCATI0N-A. - - Phone_..------------------------r---------- <br /> 61 (4-21. - - 1�------ ---------- - -- ----- ----- <br /> Owner's Name-L----"-,.j--—- -------- ------- - ------------ --- -------­ ­ . <br /> ----------- --- --------- <br /> - -- ------------------•---------_­---------------------------_- ------------- ------------------ <br /> Address--------------- --- -- ------ - ------------------ <br /> _�? - Phone----------------------------------- <br /> Contractor's Name----------- --------------------------------i --------- - ------------------ ofel 0 Other 1-1 <br /> Installation will serve- Residence Apartment Hous Commercial [] Trailer Court E] M <br /> ----------------------- <br /> Number of living units: ___1_-_ Number of bedrooms ----ZNumber of baths Lot size <br /> Water Supply: Public system F1 Community system El Private 0 Depth to Wafer Table IJ-Iff. I <br /> Character of soil to a depth of 3 feet: Sand F-1 Grav6I C] Sandy Loam El Clay Loam El Clay E] Adobe g—R-ardpan C3 <br /> Previous Application Made: (if yes,date-----------:--------) No P--'_N_ ew Construction- Yes A--Iqo El FHA/VA: Yes E] No �' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 200 feet.) <br /> (No septic tank or cesspool permitted if public sewer is available within <br /> Septic Tank: stance from nearest wellu-4 <br /> ff---------Distance from foundation/ -------------Material------- --- -------------------�---�----------- ----- <br /> Septic. 0 9 <br /> -I-------------Capacity____jF'� 9�a--A <br /> No. of compartmenfs---.2-------------(------y Size...3 _7------Liqui <br /> Disposal Fie4d: Distance from nearest well,5_0 ---------'�Distanca from foundation-./- r----------Distance to nearest-lot line,_L57._ ­_1 <br /> Number of lines___.__ Length of each ------------------Width of trench._Z-/------------------------- <br /> +I;/� <br /> - ------ ---------- - li� ----------------------- <br /> Type of filter mater5a_____M` cA-----------Depth of filter material-1-Y---------------Total length------ <br /> Seepage Pit: Distance to nearest well_---_.-- --------Distance from foundation--------------------Distance to nearest lot line-------------- <br /> ---De 'th-------------------------------- <br /> Number of pits______----------------Lining material__-___-_ <br /> Size: Diameter--- p <br /> nt ---------------::-------------------- <br /> Distance from nearest well-----------------Distance from foundation__._______---------Lining material <br /> Cesspool: .Depth------------------- -------------------------------Liquid Capacity-.. ------------------------gals. <br /> 0 Size. Diameter--------------------------- ---------- <br /> I-Distance from nearest building------------------------------------------ <br /> "T_i4a—nc;_-­f'rt_m nearest 6 -------------------------- ------------- --Dist <br /> Privy- $ e well-------------'----------------- _A­i7- -------------------- ---------- <br /> Distance to nearest lot line------ ------------------------------------------ --------------------------------r��------- <br /> I <br /> Remodeling and/or repairing. (describe)___________________________________.__---- �X <br /> ---------- ------------- <br /> ----------------------------------- --------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------ ---------------- -------------------------------------- <br /> -------------------------------------------- ---------------------------------------------------------------------------------------------------------- ------------------------ <br /> ----------------------------------------------------------------------------------------- <br /> ---------------- ifh San Joaquin County <br /> ----------------------------------- ------------------------ and that the work will be done in accordance w <br /> I hereby certify that I have prepared i ap YPI, a" S_ <br /> a e d <br /> ordinances, State laws, and rules and reg tion T the San Joaquin Local Health District. <br /> -----------------------------------------(Owner'and/or Contractor) <br /> on <br /> (Signed)------------------------------------------------- ------ -- ---- ----- ----------------:-- ------------- A <br /> .... -----------------------------------(Title)------ -------------------- ------------- ...... <br /> By:------------------------ --------------- - -------- - ---------- ------ --------- <br /> 'ca-t.0 0 system <br /> am in relation <br /> placed on reverse side). <br /> wells', buildings,(Plot plan, showing size o oc tion of system in relation to w etc., can be <br /> FOR DEPARTMENT USE ONLY <br /> DATE-------- --- ---------------- <br /> APPLICATIONACCEPTED BY----------------------------------- --------------------------- -------- <br /> REVIEWED BY-------------------------------- ------------ ------------ ----- --------------------------------------------- -------------- DATE----------------I-------------------- <br /> -------------------------------------------- <br /> BUILDINGPERMIT ISSUED---------------------------------- ----------------------------------------------------------------- <br /> Alterations and/or recommendations:------- ------------------------ ----------------- ---------------- ----------------------------------------- - <br /> --------------------------------------------------------------------- ---------------------------------------- ---------------- --------------------------------------------------------------- <br /> ------------------------ <br /> --------- --------------I----------------------------------------------------- ---------------- -------------------------I--------------------------------------------- -------------- ---------- --------------------------- <br /> ------------------------------------------ --------------------------------- <br /> ------------------------------------------------------------------------------------- ------------------------ ---------------------------------- <br /> i ---- -------------------------------------- ------------------------------------------ - ---------------------------- <br /> ------------------------------------------- ------------------------I------- ---- --- ------------- <br /> 1_4 <br /> ------------ - ----------------------------- <br /> SAN <br /> INSPECTION BY:-.---�w ..... .. ­--------- <br /> bate f <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxellon MO. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stocklon,California Lodi,California Manteca,California Tracy,California <br /> FS 9 REVISED 93-59 3M 3`63 F-F,C0. <br />