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FOR OFFICE USE; <br /> --------------------------------------------------------- <br /> ---- -APPLICATION FOR SANITATION K-AMIT Permit No. <br /> - - <br /> 5------ ------- ...... --- -------------------------- (11) <br /> ----------------------- --------------------------------- (Complete in Duplicate) <br /> (211 <br /> ---------------------- --------------------------------­ I This Permit ExDires I Year From Date Issued Date Issued <br /> 11"IPP lication is hereby made to the San Joaquin Local Health District�for a permit to cons <br /> This a Ii f" .' . ade in compliance with County Ordinance No 549. construct a, "stall the work herein described. <br /> tt pp ica ion is m <br /> JOB ADDRESS AND LOCATION <br /> ------?F654111111* 16 <br /> Owner's Name__ -------- ------ V- ---------------- ------------------ <br /> r -- ------­------ ------- --- ------------------------ ----------- Phone <br /> Address-------- . ...... ---------- <br /> --- ------------- <br /> ---- --- ------ -------------- <br /> ---- -- --- ------- ­&-------------------------------------------------------------------------- <br /> Contractor's Name____...__- li <br /> ---------;��---- - ---------------------- -------------------------------------------- Phone--------------- <br /> Installation will serve: Residence El Apartment House El Commercial El Trailer Court El Motel F] Other <br /> Number of living units: Number of bedrooms ------- Number of baths Lot size ------ea-e-1- <br /> --------------- <br /> F] Community system E] Private Depth to Water Table ft. - --- ---- - <br /> Water Supply: Public system ------------- <br /> Character of soil to a depth of 3 feet: <br /> Sand El Gravel E] Sandy Loam ER-111clay Loam E] Clay Adobe [I Hardpan'El <br /> Previous Application Made: (If yes,date--------------------) No ❑ New Construction:. Yes [I No E] FHA/VA; Yes E] No Ej <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic nk: Distance from nearest well---- Distanc romiounclation�----/0 <br /> depth__ Z/-----------------Capacity---- <br /> No. of compartments-------7�= ---- -.Materia!______42.4_7A4!2, <br /> Disposal Field. Distance from nearest w 11 -96 --..._____Distance from foundation----1.0----------Disfance'to nearest lot line-J7- <br /> Number of lines______________ Length of each line------I-00,t------------Width of french <br /> --------------------- <br /> Type of filter material---- Depth of filter material------ <br /> Seepage Pit: Distance to nearest well __________Total length___.i Q <br /> -0 <br /> .1 <br /> ------Distance from four�clatiion-------------.__Distance to nearest lot line_._---___.____..- <br /> F1 Number of pits----------------------Lining material- ------------- -------Size: Diameter-------------- --------Depth--------- ----------------------- <br /> Cesspool: Distance from nearest well_________________Distance'from foundation i ' <br /> ❑ Size: Diameter--------------------------------------Depth={-----------------------------------------------Liquid <br /> - -----------------Lining material aterial_-._______-_-__.__. <br /> ---------------- <br /> ------------------------------------------------Liquid Capacity_ .------------------------gals. <br /> Distance from nearest well_________________---------- --- ---------------Distance from nearest'bu;Jding----------------------------------------- C <br /> F1 Distance to nearest lot line_______ <br /> ine------ <br /> Remodeling and/or repairing (describe):_.__--_-_ __ ____________-- -- ------- ------------- <br /> -----------------_------------I------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ---------------------- -------------- ----------------- ?-� I - — 1- <br /> ------------ -----------t <br /> ---------------_------------------------------------------------------------------------------------------------------ <br /> --------------------------------------------------------------------------------------------------------------- I <br /> ------------------------------- -------------------------------------- --------- <br /> fi <br /> I hereby certify that I have prep6ed this application and that }he---w'_or_k__wi_11----be done in accordance with San Joaquin County <br /> ordinances, State la and rules and regulations of the San Joaquin Local Health District. <br /> (Signed),-------- <br /> -- -- -- - ------------------------- .......... . --------- - -------------------------------------------------------------------------z_�___ nd/or Contractor) F4- 1, <br /> By:----- ............... ...... 4Lro <br /> - <br /> --------------------------------------------(Title)------------------ <br /> --- - - ------ ------ - - ----- - -- - <br /> (Plot plan, showing-'s'ize'of-lot,--Ioca-fion--o-f--syst-e-m--in relation to wells, buildings, e+c., can be placed on reverse.-side). . ...... ......... <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_ - --- -------------------------------------- <br /> -------------I----- DATE <br /> - ---------- -- <br /> REVIEWEDBY ------------------ ----�__ /......�_j- --------------------------- <br /> BUILDING PERMIT ISSUED ---------------------------------------------------------- DATE--------- -------------I------------------------------------ <br /> Alterations and/or recommendations: DATE-------_------------------- ................. .............. <br /> -------------------------------I------------------------------ ----------------------------------------------- -------------------------------- ------i-------------- ------------------------------- <br /> --------------------------------- ----------------I........ <br /> -7--------------------------------------------------- - <br /> ----------------------------------------------------------------------------------------------------- ------------------------------- ------------------------------- ------------------ ------------------------------- <br /> ----------------L------------•---------------- <br /> ---------------------- ------------- ------- <br /> --------- <br /> I-------------------------------- ----------------- <br /> --------------------------- -------------- I-------------- ----------------- ---------------------------------- <br /> -- --------------------------------- ----------------- -------------- ---------------- --------- <br /> ------- --------------------- ----------------------------------- <br /> FINAL INSPECTION � -------------------- Date----- ----------------(04 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT - <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 varvISED E3_59 3H 3-63 F.Frlro. <br />