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FOR OFFICE USE; <br /> ------ -- -------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. _.A�,1_ 2,2_0---- <br /> ...................... --------------------------------- <br /> AI <br /> ---------------------- --------- ------------------------ (Complete in Duplicate) Date Issued .26-/ <br /> ---------------------------------------------------- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the Sci-ri Joaquin Local Health-District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordin n <br /> JOB ADDRESS AND 10GAT-10-llzv4 ­_1Q:1-.- <br /> Owner's Name = -- <br /> A, <br /> ------------------- --------------------------------------- -- Phone.---------------...... <br /> ---- ------------ <br /> --------------------------- ---------- <br /> 4� --------llw_�e ------ ------------------------------------------- <br /> iWo <br /> ---------- ---------- <br /> Address............. <br /> Contractor'sName------:'-_- ----- ------------------- ------------------- Phone----------------------------------- <br /> installation will 'serve: e gi—Apartmerif;ToZ_se E]__Commercial E] Trailer Court [:] Motel F] Other [j <br /> Number of living units; --/.- Number of bedrooms Nti`mbe�r6f'btZths -/..- Lot size - --------------------------------- <br /> le <br /> Water Supply: Public,system 9?1Community system-[] -Prjva+8'E] Depth to Water Table��_ ft. <br /> Character of soil to a,depth of 3 feet: Sand Gravel-F] Sandy Loam E] Clay Loam 0 Clay E]I Adobe 2Hardpan 0 <br /> Previous Application Wde: .(.I.f-yes,dote---- *---_.."__1 No 21 New Construction: Yes-El_-Up.[R_� FHA/VA: Yes El No gi— <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic fank'or cesspool permitted if public sewer is available within 200 feet.) <br /> Sed ref <br /> ptic V <br /> S�tic Tank. Distance from nearest well______.________—--------Distance from foundation---,/--------- <br /> I <br /> No. of compartment,..- A--- ------- - S;,e-" e --.Liq-'Id cleptk--- -------------Capaci ---------- <br /> Dispq.5,al Field: I Distance from nearest well_________________Distance from foundation.. ---t=Diita7ce to nearest lot line----------------- <br /> nes---------------------- <br /> Number of lines-----------------------------------Length of each line------------------------------Width of trench.------------- ------ ------------ - <br /> .1 Type of filter material-------------------- ----Depth of filter material--------------------- -Total length----------------------------------------f� <br /> 0 M at Distance to nearest lot line <br /> F�i - %I <br /> Seepage Pit Distance to nearest well- ----------------Distance,-f <br /> Number of -------------Lining material- Te:_D1a-meter-—-- --------Dept <br /> L <br /> L <br /> Cesspool: Distance from nearest-well-----------------Disfance­�,yndaflbn - ---------------- Lining material-"..-____..__._______._.______.._.:;? <br /> Size: Diameter---- -----------------7777�h=__'_ ---------------------Liquid Capacity---------------------------gals:;; <br /> '1 .T <br /> Privy: Distance from nearest-`well-------------------___________._.__---._.__"...Distance from nearest building--------------------------------------- - <br /> ❑ Distance to neAstjot Ijne—--------------------------------------------------------------- --------------------- - ----- - - ------------------------------- <br /> t� <br /> and/or repairing-[-describe):--.- <br /> Remodell ----------- --------- <br /> -------------------- <br /> ------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------- --------------------------------------------------------------------------- ---------------------------------------------------------- <br /> - -- ---------------------------- - -- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared This application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of_fhe_San,Joa-qu'p-l­G_caI Health District. <br /> (Signed)------------------------------------------------- ----------- <br /> - - ------ ----- - -- --------- --------------- ----(GivimernAird/or Contractor) <br /> By:--------------------------------------------------------------------------- ---------------- --- ------ <br /> (Plot plan, showing size of lot, location of system in relation + oils, buildings, efc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY;'- <br /> APPLICATION ACCEPTED BY---------------- --------------------------- ---------------------------- DATE---------- f� �7��� 5 <br /> REVIEWED <br /> ATE----------- <br /> REVIEWEDBY-------------------------------- --------------------------------------------------------------- --------- DATE--------------------------------------------- <br /> BUILDING PERMIT ISSUED---------- -------------- -------------------- DATE <br /> ----------------- -------------- ------------------------ <br /> PAlterations and/or recommendations-. 140 -------------------------------------------------------- ----------------- <br /> ------------ -­------ ---------------- ---------------------------- -------------- -------------------------------------------------------­------------------------------------------------------------------------------ <br /> ---------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------- -------------------------------- <br /> ------ ---------- --- ------ - -----­ - ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ------------------------------------------- ------------------------------- ............. --------------------------------------------------------------------------------------------------- ----------------------- <br /> Z ----------------------------- <br /> FINAL INSPECTION BY:.,---- e - ----- --------- ---------- Date--------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave.-. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> Z1, <br />