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FOR FFICE USE: ;; T <br /> i0 <br /> ------------------------------- ----------------- <br /> ------------------------------ <br /> APPLICATION FOR SANITATION PERMIT Permit No. ...1.�7 �r---,- <br /> - <br /> ------------------------ <br /> ----------------------"--- (Complete in Duplicate) Date Issued ....................... <br /> This <br /> -------------------- ---- <br /> _-_.- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a p rmit t construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. Ip J!�l41V TECH <br /> JOB ADDRESS AND LOCATION-----' eXiCLS----•--------=�1�.43`09Z ___JCc'r- .--- <br />' Owner's ------ ---------------•------------------------- Phane�Q[dI � ,6©O <br /> Address------------`--tZ... IAIF--------tY.7X_4,E.T.....--_----- ...��''� �i�i3�4'/s�.Q.. �� �.��.z.l,FQ.��•f <br /> Contractor's Name---- '.fJa. �. 'f ........O----'X0 ----------/WCl----------------------------------- Phone.._,60...�-'--96q . <br /> i Installation will serve: Residence (M�_Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living unit: __ ... Number of bedrooms J_rNumber of baths Lk' Lot size ....---- °•R -•-•------- ------ <br /> Water Supply: Public system ❑ Community system �rivate+.❑ -Depth'to Water Table .L_ ft. <br /> Character of soil to,,a depth of 3 feet: Sand Gravel ❑ Sandy Loam:0Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> �_ , <br /> Previous Application Made:I�llf yes,date--.-_--------------) No New Construction: Yes Er ❑ FHA/VA: Yes ❑ No�� <br /> F <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> NosePtic.tank or,cesspoolermitted.if, pu.b� c sewer_is availeble_within.200_feet., - - <br /> from ondaoMaterial..SP tic Tank: Distance from nearest well-----------------Distance <br /> r Ti 1467— of compartments------------------------•-Size----------_-•-----------•----liquid deph--------------------- <br /> .-.._Capacity-------- <br /> ---------•-.. <br /> Dispos Field: Distance from nearest welL�C�C?_�.-._Distance from foundation-AQ,_�_.-...--.Distance to nearest lot line.. <br /> Extsrihr& Number of lines----------------a ---------------Length of each line--..�__A 0--T-_----------Width of trench...---1_?'1_Z._'1....... ----•- <br /> //�� -pa Type ofifilter mate rial._.-C1si--_-_-Depth of filter material-----Jd r ------.Total length----------- �?. _'.............. <br /> Seepage Pit: Distance to:nearest well-_-...-----------------Distance from foundation....................Distance to nearest lot line................. <br /> of; its Lining material-----------------------Size: Diameter------------------------Depth----............................. <br /> w <br /> Cesspool: Distance from nearest well---__----------Distance from foundation------ ------------Lining material...----_.---.-..-__--_----------_-.-- <br /> um er <br /> ❑ Size: Diameter:`.=='----------------•-------• ---Depth--------------------- --------- - Liquid Capacity gals. <br /> II � _ ` _ - r <br /> LPrivy: Distance from­nearest well------------------------------------•------------Distance from nearest building------------------------------------------ <br /> 0 Distance.to'nearest lot line-------- _ - -----------_ -----------------------•-------- <br /> Remodeling and/or repairi! g (describe):--------�Ot�--------.....CXlS;1Z�_a.-----c5',�r'S7Z�C?1-_r....----•-•-•------•................•-•- -- ..... <br /> -x l- - Ai I.RBt-G�_rr© <br /> r. <br /> r � <br /> ' --_-_._ .»----------------------------------------------------------------------------••..--_-_.......---_-----_.-.------.i---------- <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 the San Joaquin Local Health District. # <br /> (Signed) <br /> Iso------------ -----------------------------------------------(Owner and/or Contractor) <br /> 'F s r - {Title)----- t� —•_•.. <br /> --- <br /> -- - <br /> (Plot plan, showing size Of lot, locati �Ysfern in relation to wells, buildings, etc., can be placed an reverse side). <br /> I FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---�-ft. -------------------------------- ------•--•------------------------ DATE - � 2 <br /> REVIEWED BY------------- ---- 'r :, ,. ' -- .--r k3 + . 1 i--- <br /> DATE----- ----- <br /> BUILDING PERMITISSUED--------- -----•-----=--------------------------.--------------_..----.... DATE <br /> Alterations and/or recommendations:--- --------- ----------- l 1 ! <br /> -------------------------•------•----.....-----------..._........._... <br /> I- •----------------------------------------------•--•--------------•-------------.:. <br /> l <br /> ...................----------­------- ------------ - •------- -•--•---------• -------- --- <br /> ------- <br /> --------------------------------- -----• .... -•------ <br /> FINAL�INSPECTIO(3�B°� i = == R - r---- ----- ---- - -j------------- <br /> -_ ;Date- ��I~ b- .--•--..... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South Amerlcan Stne� 300 West Oak Street 124 Sycamore Street 305 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California. <br /> li <br /> E8 9 REVISED 8-99 pM $-et ATLAS <br /> ii <br />