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rlljr% <br /> ------------------- <br /> -------------------- - APPLICATION FOR SANITATION PERMIT Permit------------- ---------- No. <br />---------------- - ------------------------------ (Complete in Duplicate) qq <br /> o <br /> ------------------------------- ---------- ........ This Permit Expires I Year From Date Issued Date Issued <br /> Application is hereby made to.rthe San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with Count 0 ante No. 549. <br /> JOB ADDRESS AN CAT N <br /> --------------------------- ......................I................... <br /> Owner's Nam <br /> , V --------- ----------------- ------------------------------------- Phone..-------:.......................... <br /> Address---- ?-Z,I g_ -Z I <br /> ..................... ------------- -- ----- • ......................... ............................... <br /> Contractor's Name.- - - - ------------------------------------------------------------------------- ------- Phone-----------....._-•----.......... <br /> Installation will serve. Residence Eli Apartment House [-] Commercial C] Tra u rt F] Motel ❑ Other <br /> Number of living units: :!............ Nu ber of bedrooms -------�.. Number of bath/..._._.t?pt size -------- <br /> Water Supply. Public system a:unify system E] Private [-] Depth to 'Water Table ft,�_ ------- "i <br /> Character of sail to a depth o. f:!3 feet: Sand E] Gravel E] Sandy Loam Ej Clay Loam [3 Clay [] Adobe EQ,4ardpan 0 <br /> Previous Application Made: (IfYes,date--------------------) No [] New Construction: Yes VII�o E] -FHA/.VA: Yes ❑ No 0 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspa'ol permute _iFj1UbIjc 5 wer is available within 200 feet.) <br /> Se t' T k 1� i 0 -7 i . I-(?;. <br /> Distance from nearest well fppm founAation---R-S------ ........... <br /> No. of compartments--------9--------- - -----Liquid clepO----Y'72—--------Capacity_ <br /> Disposal laid: Distance from near, --- <br /> t ---- Length of each line. <br /> est wellls"�_ .-Distance from foundation_j�L -----Dista`nce,to nia'rest 18t line.,__-... <br /> Number of[linesA.... ... ---i? <br /> /,S -- ---- ,,.--_Width of trench g..Z...................... <br /> Type of filter material. V..--Depfh of filter <br /> 11 _Ddl material-----Z9 -_Total length-------- <br /> Seepag -Pit: Distance to nearel well__— )2­014-V,DistanCDfr m lot line_!___,:�........... <br /> kundation--- -------Distan�q to nearest <br /> Number of;'p;ts---- ---------------Lining material/.-P -_-Size: Diameter.-33------------Depth---- ------------ <br /> ` ,i I L............... 'q\ <br /> Cesspool: Distance from nearest well_________________Distance from foundation------------_------Lining material_.-....._____________-_......__..___. <br /> Size: Diameter-------------------------- ----------Depth--------------- ------------------------------Liquid Capacity.......... <br /> ---------_--...gals. <br /> YdPrivy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ <br /> El Distance to nearest lot line_---------------------------------------------- <br /> Remodeling and/or repairing (describe):.------------------------------------------I........... -------------------------------------- .............................. ................ <br /> --------------------------------------------------------------1_-----------------------------------------------------------------------------------------------------------------------------------------t--------------- <br /> ---------------------------------------------------------- ------------------------------------------ ........I_---------------------------------------------------------------------4..........ji"t------------- <br /> -------------------------------------------------------------i----------------------------------------------- -----------------------------------------------------------------------------------------­---- -------- <br /> I h,,ferebe ify that I hav; prepared this application and that the work will be done in accordance with San Joaquin County <br /> laws. <br /> ordinan . fa laws, and rules and r ulaflons of the San Joaquin Local Hqalth District. <br /> e —a <br /> (Signed)_ . . ............. . .... ...... <br /> V------ - ----------- --- -- ----- ----------------- ------- -------- -- ----j__.,-/Owner and/or Contractor) <br /> --- --------- ------ .... .. <br /> ------------------------------------- ------ <br /> By:................ Title <br /> � ­___.­........................ <br /> .............. <br /> (Plot plan, showing size of lot, location of system in relation to wells, buiVIngs, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY 9 <br /> APPLICATION ACCEPTED BY <br /> /-------- 4-- —------------------ DATE-•---1------ -. :- <br /> REVIEWED <br /> ATE-----1------- <br /> REVIEWEDBY........................... --- ------------------ ------------ ----------------------------------------------------------- DATE....-I------------------------ <br /> BUILDING PERMIT ISSUED-- ------------------------------------------------------------------------------------- DATE.------I---------------- <br /> Alterations and/or recommendations------------------ --I------------------------------------------- ........................................ <br /> ------------------------ --------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ........................----------------------------------------------------------------------- ------------------------------------------------------.................................... --------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------ -------------------- ------------------------------------- <br /> -------------------------------------­­............. <br /> ----------------------------------------------------------------------------------------------------*--------------------------------------------------*---------------- <br /> FfNAL INSPECTION ByZ4Q)--- Date.----- <br /> . 1! 3z-- �---- -_ Z------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Srr"t 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lad],California <br /> Manteca,California Tracy,California <br /> KS 9 REVISED a-59 21A a-61 ATLAS <br />