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FOR OFFICE USE: <br />----------------- --------------------- ------------ ermit P <br /> APPLICATION FOR SANITATION PERMIT I I No. . <br /> ,�, /;2- <br />----------------------- ----------------- --------------- (Complete in Duplicate) D Isued ............. <br /> le- <br /> ----------- <br /> This Permit Expires 1 Year From Date Issued 4 <br /> ' <br /> ApplicatioA is hereby made to the San Joaquin Local Health District for a permit to construct and in r wibed. <br /> This application is made in compliance with County Ordinance �0. 549. <br /> -------------------........ <br /> JOB AS ANS <br /> ADDRESS )LOCATION---? <br /> ` � : - w <br /> Owner's Na -- -- - <br /> �14� <br /> . . ........ ---------------------------------------------------- Phone_!-----_-.-------_------------- <br /> ----- --- <br /> .................I.......... <br /> Address-_----------- ..............................--------------------------------------- - <br /> t, 1 .. .. <br /> Contractor's Name..--'------- ............. ....................... ................ .................... <br /> Phone.1 ........er 0 1 <br /> -40ff <br /> Installaflon will serve: Residence E] Apartment House ❑ Commercial E] Trailerg Motel E2 Oth <br /> r. <br /> Number,of living units: J---- Number of bedrooms ---/. Number of baths -------- Lot size2. <br /> Water Supply: 'Public system 0 Community system El Private;4 Dopth to Water Table -------- ft. ' <br /> Character of soil to a depth of 3 feet: Sand C] Gravel [] Sandy Loam-9 Clay Loam [I Clay F] Adobe(3 Hardpan C3 <br /> _1 No New Construction: Yes R) No 0 FHA A. Yes 0 No [3 <br /> Previous Application Made. (If yes,date-----__-- V�. <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> P...... Material .......... <br /> Septic Sank: Distance from nearest Distance.,from/foun0ji.ri__1 ----- -- <br /> -�apdcity-----V-60-t <br /> No. of compartments--------- .........Sjze__9_.X:;�----X.��_Liquid clep�h------- ------------t -0/1M <br /> 9 i 11 nearest lot line-. ......... <br /> Distance from nearest well.,5-0- 'Distance from foundation----Z.d�__-.-.Distance to neare <br /> Disposal Field: V1 ( <br /> Number of lines....... ---------- Length of each of trenck------- <br /> Type of filter material.......16�--------.--Depth of filter material..-----/;--------Total length.... -----------yo <br /> Seepage Pit: r `Distance to nearest well----------------------Distance'from foundation-------_-----------Distance to nearest lot line...._._....._.... <br /> pits--•-------------------Linin Linin <br /> f oma't <br /> r D .,;eNumbe <br /> enal........----------------Size: Diameter------_--------------Depih__--------------------------- <br /> g: <br /> Distar�ce frort lm nearest well------_-------L-_'Disfance from fou'ndation--------------------Lining material-----------I------------------------- <br /> Cesspool: i <br /> Size: biameter.-------------------------------- ----De'fhz./-------------------------;�-------------------Liquid Capacit�..------------_-----------gals. <br /> El P <br /> -----------.. ............... <br /> Privy: Distance from nearest well--- ----- ------Distance'4rom nearest build <br /> .1 s11 ,- .. 6 _r - f IN-, ----­------------9----❑ -_-----------_-------------- <br /> ................ <br /> Distance to nearest lot-line_i ------ ------III - <br /> Remodeling and/or repai�ing -------q21------------------------------------------------------_---------------Z, ................f-------............. <br /> i .. . i I A� ­ -----------------­-_•----- <br /> f ------------------------------------------- ----------------- <br /> ..............------------------------------------------------­------I----------------- ........ ........ <br /> �r 1 41 ---------------------------------------------------1K------------ --------- -------- <br /> ------------------------------------------------------ --------------------------------- -------------- <br /> -­------------------ <br /> ------------­----------- <br /> ----------------- <br /> ----------------- .........I. .................... ------- -------------I-------------------------------------------------------------------- <br /> I hereby certify-".fhai.4 have.prepared this application and-that-the work will be done-in accor&6Ze witg San Joaquin'dounty <br /> ordinances, State laws, and rules and regulations of the San,,Joaquin Local Health District <br /> Contractor) <br /> --------------------------------------------------------------------------------------Owner and/or Con <br /> (Signed). <br /> V <br /> --------------- <br /> -------------------------------------------------------------------------(Title)------------------------- ----------------- ----------------- <br /> BY:-------------- --------------------­- ' �L side).' <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed an revers ide).' <br /> FOR JDEPA T ENT USE ONLY <br /> APPLICATIONACCEPTED BY____.� --- ------ ---- - ----------------------- _:---------- -------- ---------------- -DATE_._. -._1------------------ <br /> R Y ------------------ DATE.----------------------------------------------------------- <br /> -------- ---//------------------------- <br /> .. . ... ........... .......... --- ------------------------- -------­---------­ <br /> i ��� �6 <br /> REVIEWED BY------- <br /> -------U--------------- - DATE.... <br /> ----------- <br /> Ul ----------- ---- --------------------------------------- ------------------ -------------------------- <br /> - ---- ------- ------------------ <br /> - -------------- <br /> ING PERMIT ----------------- -------V <br /> BUILD TISSUED---------- - $ <br /> Alterations and/or recommendations:_----------------------- ---------------- -------------------------------------------------------------------------- <br /> ------------------------------------------------!l!-------------I------------------------ <br /> ---------------------------------------------------------------------------------------------------------------- ----------------------- --------­­---------------!l:---------------------- ---------- <br /> --------------------------------------------------------------------- ---------------- --------------- ------------­-------------------------------- <br /> ------------------------------------- <br /> ------ ---------------- <br /> ................... ............... ----- ---- --- -- - ----------I---------------------------------------------------------------�i-0------------------------------ <br /> -------------------­-----_- <br /> ---------------------------------­---------------------- - - ------------- ------- ----- -- -------------------------------------­----------------*--------------------- <br /> 2-L <br /> Date_------------_ --------------- <br /> -- <br /> FINAL INSPECTIO -------- -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> EB <br /> 9 REVISED B-59 21A 5-61 AILAS <br />