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SANITATION PERMIT <br /> Permit No. <br /> �a APPLICATION FOR SAN <br /> I (Complete in Duplicate) Date Issued <br /> This Permit Ex fres 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a perm °tpjc c an <br /> 0g;&4 k herein descried:; <br /> This application is made in complian with Cou =rdinanc:;_'N_67. 549. <br /> ------- ---- <br /> JOB ADDRESS ANT14 WATI. __­ <br /> Z � _. Phone.------------•------------- <br /> ----- -------------------- ------ <br /> a ---------- <br /> ---- ' ' __ <br /> Owner's Nam ----• -- - <br /> -- ---S►[1+!�.--------- --------------------------------•------------ <br /> (��.5w <br /> Address----•- -- x ; . ---------------- <br /> ----- one :.. <br /> -- <br /> Ph -- -._ <br /> Contractor's Name_____________`- ! ; - Motel Other ❑ i <br /> -Commerclal ❑ Trailer Court 4 <br /> Installation will serve: Residence ❑ Apartment House ©J ; <br /> I --d-? ---3--7- ---- -------------- <br /> _.+"� Number of baths ________ Lot size __-- - " + <br /> Number of living units', Number of bedrooms .0 r, <br /> - Depth to Water Table _ -- ft- <br /> Water Supply: Public system ❑ Community system ❑j Private DeP Adobe Hardpan ID <br /> PP Y� Clay Loam ❑ Clay ❑ <br /> Gravel i 'Sandy Loam ❑ Y <br /> Character of soil +o a depth of-3 fes+: Sand ❑ i� a FHA/VA: Yes ❑ No <br /> Previous Application Made: Yes t❑ .N <br /> New Construction.:--yesNo F1 <br /> -N ___k <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: r <br /> No septic tank'or cesspool permitted if public sexrer is available within 2dd feet.)r ---" <br /> fo ndati9n----rb------ Materia; ._ <br /> Septic Tank: Distance from nearest w I___�f1 ---Distance r9 � Liquid depth ____-4 _ .. _____.Capacity_s. r <br /> No. of compartments_,_----•- Size__. ¢ <br /> , f � Dis# nce o nearest lot lir�e___�------ <br /> /� Distance from founds n__-- - ----- lyath c :/ -------- <br /> pisposal Field: Distance from nearest w Len th of each line__�_Ja_6 / lir <br /> Number of lines <br /> ----------- f�F�+ h. TV-=------------------ <br /> �( -•'t �' -. _Total le � <br /> _-_De th of filter materia4___,�{ - ; =1. ,. <br /> Type of filter matE nal_____f -a -- p `J I <br /> i 1 � f � Distanc�� fro ndation____��l._____Distance to;nearest,lot line]-_- ------- �-- <br /> Distance to nearest e1{__. --G --------- � &- _--._--Deptn_-_=- <br /> Seepage Pit: 1 Mize: Diameter <br /> Nurinber of pits--__5 -------- ---- Lining material ._ s <br /> Distane from foundation------------ R----.Lining material---- ---;-------- <br /> Distance-from nearest well__-- - ------ l______Ligl id Capacity-------=----------------- <br /> -------- <br /> ------------ -- gals. , <br /> Cesspool: "` t <br /> Size: Diameter-------------------- - ° Depth_ r <br /> ❑ Y i �y---------------- -Distance from?nearest building-------- ------- <br /> l Privy: D'stance from nearest weiL----j--------- -=--------- ., : 1 --........--•--'------ ------"-,---" <br /> -------------------------•--- J- <br /> ---- <br /> ❑ Distance to neare�t lot line----- ----------- .---- ---ti ------------------------------------- <br /> 0 i-,-•-. --- -----• <br /> I r ----------------- <br /> y <br /> rr�___.. <br /> iI <br /> 1 r ----------------- <br /> ii <br /> ___} <br /> Remodeling and/or r�paEnng._{descr4be�------------ ------------------`-- -----�--- ---°------•-------------------------•---•---•-------•---------- <br /> ------ ------ 4 <br /> ------------------__.__________________ j t I __________ - <br /> _ !i"~ <br /> ___________________ __j__.____ .�________ __,__________.___.__.___________________-______-______-__-__-_,-____ <br /> J _-__.._- , _ _ <br /> ! hereby certify that I have irepared this application and thaq}.+he work wtfl be da� in accordance with San Joaquin County <br /> l ' <br /> ordinances. State I aws, a les and;regulations hof the San Joaquin Local Health 1 iso . <br /> n. <br /> -(Q <br /> or°and�orCon+ c+orine <br /> - �J <br /> _ <br /> (Signed) , <br /> �, � � �--`---- ------------- --�-- -----Title}------'-- - ---`"_'-- ---------------- - - -- -----, ----- <br /> ------ = <br /> [Plot plan, showing sizeof to}, location of system in relation to wells,buildin s, etc., can be laced on reverse side). 1� <br /> f { Y t. <br /> l FOR DEPARTMENT USE ONLY-_;4 ► i <br /> --- -------- DATE {�. ------------------------ <br /> ---------------- <br /> APPLICATION ACCEPTED BY-----------__ � � ' <br /> r v�,'Ctti §l - DATE - r <br /> is - DATE-------------------------------- - --------------------- <br /> -REVIEWED BY--------- ----------- <br /> BUILDING PERMIT ISSUED <br /> l -------------- --- ! <br /> r 't <br /> -•---- <br /> Alter tions and/or recommendations: 4 - ----------- <br /> recommendations-] <br /> I1 .. ------ -- ------- ; ------------- 1 <br /> (1 --�- -=------ <br /> ------------- ---- ---- --- <br /> -------- <br /> 1�- __- �.�cL!§ - ----- ---------------- <br /> � ---- <br /> - • lor <br /> l <br /> ' I <br /> s <br /> G L - � - �-. --------k--------- <br /> ----------Date � r �"C <br /> FINAL INSPECTION -- ---- . <br /> -A <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 614 North "C" Street <br /> 132 Sycamore Street <br /> 300 West Oak Street Tracy, California <br /> 130 south AmcanwStree#�� � Lodi, California Manteca, California <br /> p Stockton, California <br /> E5.q-2M Revised S-'59 F,P,Co. _ – <br />