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FOR OFFICE USE; <br />-------------I------------------------------------------ APPLICATION FOR SANITATION PERMIT permit No. <br /> -------------- ---------------------------- e A <br /> (Ci?mplete in Dupricatell Date issued Z�/ --------- <br />---------------------- -- ------------------- ---------- <br /> Date Issued <br /> This Permit Expires 1 Year From <br /> --------------- - ----- ------- -------- ------------ ," for a permit to construct and 'install the work herein described. <br /> Application is hereby made tolihe ian Joaquin Local Health District <br /> This appiicafion-is nna.de-in,cor6pliance with County Ordinance No. 549. <br /> :. . i . . I 'k - ----_--------- <br /> otWZA-e ....................... <br /> - ----- --- ....... <br /> JOB ADDRESS AN�DZCATION---A44--- <br /> ----- Phone..........-_---------------------- <br /> ---------- <br /> ........ ...........---------------------------- <br /> Ownar's'�N a me- ---------- ------r----------- --- <br /> - ------------------- <br /> r --------- ------ --------------------------------- ...................................................................---------- <br /> AddressL*._-. <br /> Motel 0 Other El <br /> ............. Phone. <br /> --------------------- <br /> Contractor's Name_ 7' ......................... <br /> - :.- - Ouse F1 Commercial E] Trailer Court 0 <br /> Installation .will serve-. Residerice"A Apartment H -------------------------...................I <br /> _4�ber of living units:`!I`-------- Number of bedrooms -------- Number of baths -------- Lot size ------------- <br /> Num <br /> Water Sul:�ply: Public system�E] Community system [] Priv ate Depth to Water Table -------- ft <br /> J�- Sand [] Gravel E3 Sandy Loam[] Clay Loam 0 Clay C] Adobe[] Hardpan 0 <br /> Character of soil to a depth 64 3 feet: <br /> '" - - I ' ;' .' 9P 1 F1 New Construction: Yes F] No E] FHA/VA- Yes 0 No El <br /> Previous'�.pplication Made: (If yes date----------------­-) No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> ilable within 200 feet.) <br /> (No septic tank or cess'pool permitted if pubVic sewer is ava T <br /> Material-----------_---------- ......................... <br /> -from nearest well-----------------Distance fr6 foundation-------------------- <br /> Distance - <br /> Ow ---------Size...... -------- Liquid dep�h--_----------------------Capacity----------------------- <br /> No. of compartments_--------------- --------- <br /> ;1: o nearest lot lin&&!�---------- <br /> nearest well---Co------..-Distance from foundatic. ..........Distance t <br /> Disposal Field: Distance1rorn Df frenc�---!��---------I------...... <br /> Number '6f lines ---Length of 6ach line___-�C`..............Width <br /> mate'rial-1,F - -----Total length..__&..4-_---------------------------- <br /> Type of filter - -- ----Depth of filter <br /> a rial <br /> Seepage Pit: D;stance4o nea._ --------------Distance frotrn� foundation....................Distance to nearest lot line. <br /> Size: Diameter------------------------Depth--------------------------------- <br /> Number'of pits----------------------Lining material------------------------ <br /> 171 ing material------------------------------------- <br /> tancj'from nearest well------­---------Distance from foundation--------------------Lin <br /> Cesspool: Dis ;% -----------------Liquid Capacity------ --------------------gals. <br /> ------------Depth----------------------------------- <br /> Size: Dia"meter-------------------------- <br /> "'I C�iistance from nearest building------------------------------------------ <br /> from nearest well------------------------------------------------ <br /> Privy- Distance ----------------------------------------------------I----------------- <br /> 0 ' Distance"to nearest lot line------------------------------------------------ ..................... <br /> ribe) ................... <br /> - --------- <br /> Remodeling and/or repairing (desc ---- <br /> -----------------------------­----------I------------------------------ <br /> --------------_---------------------.......--------------------------------------------- .......................----------I------------ -- <br /> ------------------------------------- ------I----­---------­----------I------------------ ----------------­---I----------------------------- <br /> ---------------1------------ --------------------------I... ------------------------------------------------------------_---------------------------------------------------- <br /> ------------!I------_---_----------------------------------------- <br /> ---------------------------------- . <br /> plicafion and that the work will be done in accordance with San Joaquin County <br /> I hereby certify that I have prepared this ap of +he San Joaquin Local Health District. <br /> ordinances. State laws, and:rules and regulations <br /> 11: -------(Owner and/or Contractor) <br /> eolvxlclulo -----------.......... ....... ....................... <br /> (Sighed- - ---- --- ------------I---- ------ ----------- 10$1�a------------------------- <br /> IFI��40X <br /> I !h --------------­­----------------­-ArItle)......... ---------------------------------- - -------------- <br /> - - ----------------------------------------------------- <br /> B :... . ...4 in relafion to wells, buildings, etc., can be placed on reverse side). <br /> (Plot plan, showing i 0 Of lot. location of system <br /> FOR DEPARTMENT USE ONLY <br /> DATE-- .................................. <br /> APPLICATION ACCEPTED BY- -- - -- -- ------------------------- --------- <br /> ------------------ D,,\T E------_--------------- --------------------- <br /> REVIEWED BY---- --------------------*------------------------------------------ ----------------------------------- E - ------------I---------------------------------------- <br /> DAT .---- <br /> BUILDINGPERMIT ISSUED---------------- ----------------------------- ------------------------------ ----- ....-------------------------­I------- <br /> m6ndations------------------_--------------------------------------------------------------------........... ................. <br /> Alterations and/or recom ---------------------------------------------------------------------.............. <br /> -III --------------------------------­--------- <br /> -------------------------------------------------I—----------------- ----------- ---------------------- <br /> :0�------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> .............................. ------------- - .................... <br /> 'i� ---------- ---------------------------------------------- <br /> ---------------- ---------------------------------------------------- --------- <br /> ...................................... ----------------- <br /> ------------ <br /> .......... ----------------I----------------- <br /> -------------- --------------------------------------------------------- <br /> ............ -------------------------- ------------------- <br /> -- ------------------------------------ <br /> Date_ - ------- -------- <br /> FINAL INSPECTION BY:--- <br /> ------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> 130 South American Stras Tracy,California <br /> Stockton,California 11 Lodi,California Manteca,California <br /> E111 9 REVISED 8-S9 ?M 5-61 ATLJ 1 5 <br /> t <br />